scholarly journals Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis

2019 ◽  
Vol 39 (1) ◽  
pp. 66 ◽  
Author(s):  
Wentao Zhou ◽  
Weiwei Jin ◽  
Dansong Wang ◽  
Chao Lu ◽  
Xuefeng Xu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Propensity Score Matching ◽  
Ductal Adenocarcinoma ◽  
Propensity Score Matching Analysis ◽  
Open Pancreaticoduodenectomy

scholarly journals Comparison of Minimally Invasive versus Open Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Propensity Score Matching Analysis

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 982 ◽  
Author(s):  
Jaewoo Kwon ◽  
Ki Byung Song ◽  
Seo Young Park ◽  
Dakyum Shin ◽  
Sarang Hong ◽  
...  
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Propensity Score Matching Analysis ◽  
Oncological Outcomes ◽  
Hospital Stays

Background: Few studies have compared perioperative and oncological outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). Methods: A retrospective review of patients undergoing MIPD and OPD for PDAC from January 2011 to December 2017 was performed. Perioperative, oncological, and survival outcomes were analyzed before and after propensity score matching (PSM). Results: Data from 1048 patients were evaluated (76 MIPD, 972 OPD). After PSM, 73 patients undergoing MIPD were matched with 219 patients undergoing OPD. Operation times were longer for MIPD than OPD (392 vs. 327 min, p < 0.001). Postoperative hospital stays were shorter for MIPD patients than OPD patients (12.4 vs. 14.2 days, p = 0.040). The rate of overall complications and postoperative pancreatic fistula did not differ between the two groups. Adjuvant treatment rates were higher following MIPD (80.8% vs. 59.8%, p = 0.002). With the exception of perineural invasion, no differences were seen between the two groups in pathological outcomes. The median overall survival and disease-free survival rates did not differ between the groups. Conclusions: MIPD showed shorter postoperative hospital stays and comparable perioperative and oncological outcomes to OPD for selected PDAC patients. Future randomized studies will be required to validate these findings.

scholarly journals Total laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis with meta-analysis

2020 ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Yi-ping Mou ◽  
Chao-jie Huang ◽  
Jia-fei Yan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Propensity Score Matching ◽  
Meta Analysis ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes ◽  
Low Grade ◽  
Open Pancreaticoduodenectomy

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer mortality worldwide. Total laparoscopic pancreaticoduodenectomy (TLPD) have been used in the treatment of benign and low-grade diseases on the pancreatic head. It is necessary to expand the current knowledge on the feasibility and safety of TLPD for PDAC treatment. We aimed to assess the surgical and oncological outcomes of TLPD for patients with PDAC by comparing them with open pancreaticoduodenectomy (OPD). Methods Data regarding patients who underwent pancreaticoduodenectomy for PDAC treatment from January 2013 to January 2019 in our hospital were obtained. Baseline characteristics, intraoperative effects, postoperative recoveries, and survival outcomes were compared. To overcome selection bias, we performed a 1:1 match using propensity score matching (PSM) between TLPD and OPD. We also conducted a systematic review and meta-analysis. Results The original cohort included 276 patients (TLPD; 98 patients, OPD; 178 patients). After PSM, there were 89 patients in each group and the patient demographics were well matched. Of the 98 patients who underwent TLPD, 8 (8.2%) required conversions to laparotomies. Compared to OPD, TLPD could be performed with longer operative times, had less blood loss, and had lower overall morbidities. Regarding oncological and survival outcomes, there were no significant differences in tumor size, R0 resection rates and tumor stages between groups. However, TLPD had an advantage over OPD in terms of retrieved lymph nodes (21.9 ± 6.6 vs. 18.9 ± 5.4, p < 0.01). There were no statistically significant differences between the groups in recurrence patterns, and the 3-year recurrence-free and overall survival rates were comparable between the two groups. Meta-analysis further confirmed that the TLPD were associated with longer operative times, less blood loss, shorter hospitalizations, lower morbidities, and a greater number of retrieved lymph nodes. Conclusions TLPD are feasible and oncologically safe procedures for PDAC treatments. Postoperative outcomes and long-term survival after TLPD are superior, or not inferior, to OPD, and could be a promising alternative to open surgery for PDAC treatments. Our findings should be further evaluated by multicenter or randomized controlled trials.

scholarly journals Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis

2020 ◽  
Author(s):  
Ke Zhang ◽  
Shu Dong ◽  
Yan-Hua Jing ◽  
Hui-Feng Gao ◽  
Lian-Yu Chen ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Propensity Score ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Propensity Score Matching ◽  
Prognostic Indicator ◽  
Ductal Adenocarcinoma ◽  
Entire Cohort ◽  
Propensity Score Matching Analysis ◽  
Cox Analysis ◽  
Independent Marker

Abstract Background Recent evidence suggests that albumin-to-Alkaline Phosphatase Ratio (AAPR) functions as a novel prognostic marker in several malignancies. However, whether it can predict the prognosis of unresectable pancreatic ductal adenocarcinoma (PDAC) remains unclear. Herein, we seek to explore this possibility by a propensity score matching (PSM) analysis. Methods This was a retrospective design in which 419 patients diagnosed with unresectable PDAC and receiving chemotherapy were recruited. Patients were stratified based on the cutoff value of AAPR. The PSM analysis was used to identify 156 well-balanced patients in each group for overall survival (OS) comparison and subgroup analysis. Univariate and multivariate analyses were carried out to examine the potential of AAPR to indicate the prognosis of unresectable PDAC. Results We identified an AAPR of 0.4 to be the optimal cutoff for OS prediction. Patients with AAPR≤0.4 had significantly shorter OS compared with patients with AAPR>0.4 (6.4 versus 9.3 months; P<0.001). Based on the PSM cohort and entire cohort, multivariate Cox analysis revealed that high pretreatment for AAPR was an independent marker predicting favorable survival in unresectable PDAC (hazard ratio, 0.556; 95% confidence interval, 0.408 to 0.757; P<0.001). Significant differences in OS were observed in all subgroups except for the group of patients age≤60. Conclusions Pretreatment AAPR is an effective marker that predicts outcomes of patients with unresectable PDAC, potentially helping clinicians to identify patients at high risk and guide individualized treatment.

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