Robotic versus laparoscopic distal pancreatectomy for left-sided pancreatic tumors: a single surgeon's experience of 228 consecutive cases
Robotic versus laparoscopic distal pancreatectomy for left-sided pancreatic tumors: a single surgeon's experience of 228 consecutive cases
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DOI：
10.1007/s00464-019-07047-8
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发表时间：
2020-06-01
影响因子：
3.1
通讯作者：
Kim, Song Cheol
中科院分区：
文献类型：
--
作者：
Hong, Sarang;Song, Ki Byung;Kim, Song Cheol
背景腹腔镜胰腺远端切除术（LDP）在治疗左侧胰腺肿瘤中越来越受欢迎。机器人系统代表了此类肿瘤微创手术治疗的最新进展。理论上，机器人系统被认为比腹腔镜系统有几个优势。然而，比较这两种系统在远端胰腺切除术中的应用的研究很少。我们比较了两种治疗方式的围手术期和肿瘤预后。方法回顾性分析2015年1月至2017年12月同一位外科医生在某大容量中心连续行微创远端胰腺切除术的病例。结果分析纳入228例连续患者（LDP, n = 182； robot -assisted腹腔镜远端胰腺切除术[R-LDP]， n = 46）。R-LDP组的手术时间明显长于LDP组（166.4 vs 140.7 min, p = 0.001）。在接受保脾入路患者的亚组分析中，R-LDP相关的脾脏保存率显著高于LDP相关的脾脏保存率（96.8% vs. 82.5%; p = 0.02）。在胰腺癌患者的另一个亚组分析中，两组之间的中位总生存期和无病生存期没有显著差异。结论R-LDP是一种安全可行的手术方式，围手术期和肿瘤预后与LDP相当。R-LDP提供了一个额外的技术优势，使外科医生能够在良好的人体工程学舒适的情况下进行复杂的手术。
Background Laparoscopic distal pancreatectomy (LDP) has gained popularity for the treatment of left-sided pancreatic tumors. Robotic systems represent the most recent advancement in minimally invasive surgical treatment for such tumors. Theoretically, robotic systems are considered to have several advantages over laparoscopic systems. However, there have been few studies comparing both systems in the treatment of distal pancreatectomy. We compared perioperative and oncological outcomes between the two treatment modalities. Methods A retrospective analysis was conducted of all consecutive minimally invasive distal pancreatectomy cases performed by a single surgeon at a high-volume center between January 2015 and December 2017. Results The analysis included 228 consecutive patients (LDP, n = 182; Robotic-assisted laparoscopic distal pancreatectomy [R-LDP], n = 46). Operative time was significantly longer in the R-LDP group than in the LDP group (166.4 vs. 140.7 min; p = 0.001). In a subgroup analysis of patients who underwent the spleen-preserving approach, the spleen preservation rate associated with R-LDP was significantly higher than that associated with LDP (96.8% vs. 82.5%; p = 0.02). In another subgroup analysis of patients with pancreatic cancer, there were no significant differences in median overall and disease-free survival between the two groups. Conclusions R-LDP is a safe and feasible approach with perioperative and oncological outcomes comparable to those of LDP. R-LDP offers an added technical advantage that enables the surgeon to perform a complex procedure with good ergonomic comfort.