RESUMEN
BACKGROUND: The safety of total laparoscopic pancreaticoduodenectomy still remains controversial. Laparoscopic assisted pancreaticoduodenectomy (LAPD) may be an alternative selection. The purpose of the present study is to compare a consecutive cohort of LAPD and open pancreaticoduodenectomy (OPD) from a single surgeon. METHODS: A comparison was conducted between LAPD and OPD from January 2013 to December 2018. Perioperative outcomes and short-term oncological results were compared. Univariate and multivariable analyses were performed to determine associations among variables. RESULTS: 133 patients were enrolled, 36 patients (27.1%) underwent LAPD and 97 (72.9%) underwent OPD. No 30-day and 90-day mortality occurred. LAPD was associated with decreased intraoperative estimated blood loss (300 versus 500 ml; P = 0.002), longer operative time (372 versus 305 min; P < 0.001) compared with OPD. LAPD had a conversion rate of 16.7%, and wasn't associated with an increased grade B/C pancreatic fistula rate, major surgical complications, intraoperative blood transfusion, reoperation rate or length of hospital stay after surgery. In the subset of 58 pancreatic ductal adenocarcinomas, R0 resection rate, median total harvested lymph node or lymph nodes ≥12 did not differ between the two groups. CONCLUSION: LAPD could be performed with non-inferior short-term perioperative and oncologic outcomes achieved by OPD in selected patients.
Asunto(s)
Carcinoma Ductal Pancreático/cirugía , Laparoscopía/métodos , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/métodos , Adolescente , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Transfusión Sanguínea , Estudios de Cohortes , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Fístula Pancreática/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Adulto JovenRESUMEN
Dysphagia as the first or only manifestation in thoracic aortic aneurysm is referred to as dysphagia aortica, which is usually associated with old age, women of short stature, hypertension, and kyphosis. Systemic lupus erythematosus may complicate with early aortic aneurysm onset. Dysphagia aortica in young women with lupus may be more common than many doctors realize and easily missed at the first presentation.