Seeking the Real Benefits of Laparoscopic Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma
Mené en Chine sur 200 patients atteints d'un adénocarcinome canalaire du pancréas (âge moyen : 61,3 ans ; 39 % de femmes), cet essai randomisé multicentrique évalue la non-infériorité, du point de vue de la survie globale à 5 ans, d'une pancréaticoduodénectomie laparoscopique par rapport à une pancréaticoduodénectomie par voie ouverte
In this issue of JAMA Surgery, Wang and colleagues present a multicenter randomized trial comparing 2 surgical approaches for pancreaticoduodenectomy (PD). Leveraging a previous trial of laparoscopic vs open PD for periampullary tumors, this current study exclusively enrolled patients with pancreatic ductal adenocarcinoma, emphasizing oncologic outcomes. In their article, the authors present short-term outcomes. Previous studies have demonstrated the safety and oncologic equivalence of laparoscopic PD (LPD) and open PD (OPD), with the notable exception of the Dutch LEOPARD-2 trial, which was stopped early because of safety concerns attributed to early learning curves. To ensure completion of learning curves for the technically demanding LPD procedure, the current study exclusively employed surgeons with experience in more than 104 prior LPDs, reinforced by a centralized review of operative videos. The study had well-matched cohorts between the 2 arms and performed an appropriately modified intention-to-treat analysis.
JAMA Surgery , éditorial, 2022