Pankreas Kanserlerinde Laparoskopik ve Açık Whipple Prosedürünün Karşılaştırılması: Tek Merkez Sonuçları

Öz

Amaç: pankreas tümörleri için uygulanan laparaskopik prosedür teknik olarak zor olduğu için yaygın olarak uygulanmamaktadır. Çalışmanın amacı, laparaskopik ve açık yöntemlerle  proksimal pankreas tümörleri için ameliyat edilmiş hastaları, ameliyat öncesi bulguları, ameliyat sonrası bulguları, onkolojik sonuçları ve sağ kalım sürelerine göre karşılaştırmaktır.

Gereç ve Yöntemler: 2009 ve 2017 tarihleri arasında pankreatik rezeksiyon yapılmış olan hastaların bilgileri toplandı. Açık (TPD) ve laparaskopik total pankreatikoduodenektomi (TLPD) yapılmış hastalar  bu çalışmaya dahil edildi. Hastalar, ameliyattan sonra en az 6 ay takip edildi ve tüm komplikasyonlar değerlendirildi. Komplikasyonların tümü kaydedildi ve Clavien sistemine göre sınıflandırıldı.  

Bulgular: 62 (%80.5) hastaya TPD, 15 (%19.4) hastaya TLPD uygulandı. hastaların demografik bulgularına göre farklılıkları yoktu. TLPD grubunda, kan transfüzyonu, kan kaybı, hastanede kalış süreleri, yoğun bakımda kalma süreleri, çıkarılan lenf nodu sayıları açısından belirgin farklılıklar tespit edildi. Ameliyat süresi TLPD grubunda belirgin düzeyde uzundu. Pankreatektomi sonrası kanama TLPD grubunda düşüktü. Diğer komplikasyonlar açısından fark yoktu.  

Sonuç: Laparaskopik whipple prosedürü düşük morbidite ve kabul edilebilir düzeydeki komplikasyon oranı ile sadece uygulanabilir değil aynı zamanda güvenli bir yöntemdir. TLPD, düşük kan kaybı, düşük transfüzyon oranı, yüksek sayıda lenf nodu çıkarılması, düşük yara yeri enfeksiyonu riski ile karakterizedir. Buna rağmen TLPD, ancak seçilmiş olgularda uygulanabilmektedir.

Anahtar Kelimeler

• laparaskopik pankreatektomi,açık pankreatektomi,whipple

Laparoscopic versus Open Whipple Procedure for Pancreatic Adenocarcinoma: A Single-Center Experience

Öz

Background: The laparoscopic approach for pancreas tumors is not comprehensively approved, due to its technical complexity. The aim of this study was to compare the perioperative and postoperative results, oncological outcomes and survival of patients with proximal pancreatic tumor who underwent laparoscopic treatment (TLPD) versus open procedure (TPD).

Patients and Methods: From 2009 to 2017, information of patients undergoing pancreatic resection was collected. All patients undergoing total pancreaticoduodenectomy (TPD) or TLPD were included in this study. The patients were followed minimum 6 months after surgery and all complications were analyzed. All complications were recorded and categorised according to the clavien system.

Results: 62 (%80.5) patients underwent TPD, 15 (%19.4) underwent TLPD. There were no differences in patients demografics. Significant differences were determined in TLPD group about blood transfusion, blood loss, lenght of hospitalization, intensive care unit (ICU) stay, number of lymph nodes resected. Operative time was significantly long in TLPD group. Postpancreatectomy hemorragy was low in TLPD group. There were no differences in other complications.

Conclusions: Laparoscopic whipple procedure is not only feasible but safe, with low morbidity and acceptable complication rates. TLPD is characterized by less blood loss, lower transfusion rates, improved lymph node resection, less wound infection. However, the laparoscopic Whipple procedure can be applied in selected cases. 

Anahtar Kelimeler

• Laparoscopic pancreatectomy,open pancreatectomy,whipple

Kaynakça

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