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복강경 보조하 췌십이지장 절제술: 90례의 사례 분석과 학습 곡선 분석
Laparoscopic assisted pancreaticoduodenectomy : Experience with 90 consecutive cases and analysis of the learning curve

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Authors
김성호
Advisor
한호성
Major
의과대학 임상의과학과
Issue Date
2018-02
Publisher
서울대학교 대학원
Keywords
laparoscopypancreaticoduodenectomylearning curve
Description
학위논문 (석사)-- 서울대학교 대학원 : 의과대학 임상의과학과, 2018. 2. 한호성.
Abstract
Introduction
Recent advances in minimally invasive techniques have led to increased efforts and interest in laparoscopic pancreatic surgery. Laparoscopic distal pancreatectomy is a widely accepted procedure for left-sided pancreatic lesions, but the adoption of laparoscopic pancreaticoduodenectomy for other lesion types has been hindered by concerns regarding the technical complexity of laparoscopic reconstruction. Laparoscopy-assisted pancreaticoduodenectomy (LAPD), in which pancreaticoduodenal resection is performed laparoscopically while reconstruction is completed via a small upper midline minilaparotomy, combines the efficacy of the open approach with the benefits of the laparoscopic approach. The purpose of this study was to report our experience with LAPD and define the learning curve.

Methods
Ninety patients with benign and malignant periampullary lesions who underwent LAPD by the same surgeon between March 2003 and May 2017 were reviewed retrospectively. The clinicopathologic variables were prospectively collected and analyzed. The learning curve for LAPD was assessed using the cumulative sum (CUSUM) and risk-adjusted (RA)-CUSUM methods.

Results
The most common histopathology was pancreatic ductal adenocarcinoma (n = 27, 30.0%)
followed by carcinomas of the ampulla of Vater (n = 16, 17.8%) and common bile duct (n = 14, 15.6%)
and intraductal papillary mucinous neoplasm (n = 13, 14.4%). The median operation time was 556 (range, 300-865) minutes, and the median estimated blood loss was 546 (range, 50-2000) ml. The mean hospital stay was 21.4 days. Complications developed in 33 patients (36.7%), of whom 12 (13.2%) had clinically significant pancreatic fistula (International Study Group on Pancreatic Surgery grade B/C). Based on the CUSUM and RA-CUSUM analyses, the learning curve for LAPD was divided into three phases: phase I (cases 1-26), phase II (cases 27-69), and phase III (cases 70-90). The surgical indications were significantly different between phases I and II (p = 0.001).

Conclusions
LAPD is technically feasible and safe for select patients. This procedure incorporates the benefits of both the open and the minimally invasive laparoscopic approaches, and may be a stepping stone for transition from open to pure pancreaticoduodenectomy.
Language
Korean
URI
https://hdl.handle.net/10371/142374
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Clinical Medical Sciences (임상의과학과)Theses (Master's Degree_임상의과학과)
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