Outcomes After Robot-Assisted Pancreaticoduodenectomy for Periampullary Lesions
Outcomes After Robot-Assisted Pancreaticoduodenectomy for Periampullary Lesions
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DOI：
10.1245/s10434-011-2045-0
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发表时间：
2012-03-01
影响因子：
3.7
通讯作者：
Moser, A. James
中科院分区：
文献类型：
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作者：
Zeh, Herbert J.;Zureikat, Amer H.;Moser, A. James
与传统的开放技术相比，微创胰十二指肠切除术可能为胰腺头良性和恶性疾病患者提供许多理论上的优势，包括缩短恢复时间，缩短住院时间，更早开始辅助治疗并提高辅助治疗的完成率。本研究的目的是评估机器人辅助胰十二指肠切除术后的肿瘤学和安全性结果。回顾性分析2008年10月至2010年12月期间机器人辅助胰十二指肠切除术（RAPD）治疗壶腹周围病变的前瞻性数据库。50例患者尝试RAPD。8例（16%）患者需要转开手术。在意向治疗分析中，国际胰腺外科研究组定义的胰瘘发生在10例（20%）患者中。大多数患者没有（21.42%）术后并发症或轻微的Clavien I/II事件（13.26%）。15例（30%）患者出现严重发病率（Clavien III/IV）。边缘阴性切除率为89%，淋巴结中位数为18个。15例患者符合术后辅助化疗的资格标准。15例符合条件的患者中有11例（73.3%）在术后平均11.5周接受了辅助治疗。RAPD的安全性和肿瘤预后与开放或腹腔镜入路相当。这个早期系列的结果表明，机器人辅助的方法是有希望的。需要更大、更成熟的多机构队列来探索开放和腹腔镜技术的潜在益处。
There are many theoretical advantages that a minimally invasive approach to the pancreaticoduodenectomy might offer patients with benign and malignant disease of the head of the pancreas over traditional open techniques, including improved recovery time, decreased hospital stay, and earlier initiation of and higher rate of completion of adjuvant therapy. The goal of this study was to assess the oncologic and safety outcomes after a robot-assisted approach to pancreaticoduodenectomy.Retrospective review of a prospectively acquired database of robot-assisted pancreaticoduodenectomy (RAPD) for periampullary lesions between October 2008 and December 2010.Fifty patients underwent attempted RAPD. Conversion to open procedure was required in eight patients (16%). At intention-to-treat analysis, pancreatic fistula as defined by the International Study Group of Pancreatic Surgery occurred in 10 patients (20%). Most patients experienced either no (21, 42%) postoperative complications or minor Clavien I/II events (13, 26%). Major morbidity (Clavien III/IV) occurred in 15 patients (30%). The margin-negative resection rate was 89%, and the median number of lymph nodes collected was 18. Fifteen patients met the eligibility criteria for adjuvant chemotherapy after surgery. Eleven (73.3%) of 15 eligible patients were treated with adjuvant therapy at a mean of 11.5 weeks after surgery.RAPD can be performed with safety and oncologic outcomes comparable to open or laparoscopic approaches. Results of this early series suggest that the robot-assisted approach holds promise. Larger, more mature multi-institutional cohorts will be needed to explore potential benefits over open and laparoscopic techniques.