Robotic Versus Open Pancreaticoduodenectomy: A Comparative Study at a Single Institution
Robotic Versus Open Pancreaticoduodenectomy: A Comparative Study at a Single Institution
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DOI：
10.1007/s00268-011-1276-3
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发表时间：
2011-12-01
影响因子：
2.6
通讯作者：
Giulianotti, Pier Cristoforo
中科院分区：
文献类型：
--
作者：
Buchs, Nicolas Christian;Addeo, Pietro;Giulianotti, Pier Cristoforo
微创胰十二指肠切除术(PD)仍然是最具挑战性的腹部手术之一，其应用到目前为止文献报道很少。到目前为止，很少有数据可以与微创方法开放PD进行比较。本研究的目的是比较一家机构的机器人和开放式PD方法。对2002年1月至2010年5月在一家机构连续进行的83例PD手术的数据进行了回顾。患者被分成两组：开放组(n=39；47%)和机器人组(n=44；53%)。与开放组相比，机器人组患者年龄更大(63岁比56岁；p=0.04)和更重(体重指数：27.7比24.8；p=0.01)；美国麻醉学家协会(ASA)得分更高(2.5vs.2.15；p=0.01)。两组的手术指征相同。与开放手术组相比，机器人手术组的手术时间显著缩短(444vs.559min；p=0.0001)，出血量减少(387vs.827mlvs.827ml；p=0.0001)，获得的淋巴结数量更多(16.8vs.11；p=0.02)。两组在并发症发生率、死亡率和住院时间方面没有显著差异。作者提出了一项比较开放式PD和机器人PD的首批研究之一。虽然现在就长期结果得出明确的结论还为时过早，但短期结果显示出支持机器人方法的积极趋势，而不会损害与开放方法相关的肿瘤学原则。
Minimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures, and its application is poorly reported in the literature so far. To date, few data are available comparing a minimally invasive approach to open PD. The aim of the present study is to compare the robotic and open approaches for PD at a single institution.Data from 83 consecutive PD procedures performed between January 2002 and May 2010 at a single institution were retrospectively reviewed. Patients were stratified into two groups: the open group (n = 39; 47%) and the robotic group (n = 44; 53%).Patients in the robotic group were statistically older (63 years of age versus 56 years; p = 0.04) and heavier (body mass index: 27.7 vs. 24.8; p = 0.01); and had a higher American Society of Anesthesiologists (ASA) score (2.5 vs. 2.15; p = 0.01) when compared to the open group. Indications for surgery were the same in both groups. The robotic group had a significantly shorter operative time (444 vs. 559 min; p = 0.0001), reduced blood loss (387 vs. 827 ml; p = 0.0001), and a higher number of lymph nodes harvested (16.8 vs. 11; p = 0.02) compared to the open group. There was no significant difference between the two groups in terms of complication rates, mortality rates, and hospital stay.The authors present one of the first studies comparing open and robotic PD. While it is too early to draw definitive conclusions concerning the long-term outcomes, short-term results show a positive trend in favor of the robotic approach without compromising the oncological principles associated with the open approach.