Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?
Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?
复制标题
DOI：
10.18632/oncotarget.17513
复制
发表时间：
2017-05-16
期刊：
影响因子：
--
通讯作者：
Peng C
中科院分区：
文献类型：
--
作者：
Zhang J;Jin J;Chen S;Gu J;Zhu Y;Qin K;Zhan Q;Cheng D;Chen H;Deng X;Shen B;Peng C
胰腺神经内分泌肿瘤最有效的根治性治疗是手术切除。微创手术在胰腺切除术中的应用越来越多。机器人远端胰腺切除术（RDP）的初步结果令人鼓舞。尽管如此，比较RDP与腹腔镜胰体尾切除术（LDP）治疗PNS的结果的数据很少。本研究的目的是比较RDP和LDP治疗PNNI的安全性和有效性。从2010年9月至2017年1月，收集了43例接受RDP的连续患者的初始经验中的手术参数和围手术期结局，并与31例接受LDP的患者进行了比较。接受RDP和LDP的患者表现出相同的年龄、性别、阿萨评分、肿瘤位置和肿瘤大小。手术时间、胰腺切除长度、术后住院时间、中转开腹率、胰瘘率、输血率和再次手术率均无统计学差异。RDP组患者的总体保脾率（79.1 vs. 48.4%，P = 0.006）和Kimura保脾率（72.1 vs. 16.1%，P < 0.001）显著较高，失血过多风险降低（50 vs. 200 mL，P < 0.001）。RDP组的肿瘤结局上级，G2和G3 PNM的淋巴结收获更多（3.5 vs. 2，P = 0.034）。RDP和LDP均是治疗胰体尾部PNS的有效和安全的方法。机器人入路具有术中出血少、保脾率高、淋巴结收获多等优点。对于符合预定保脾指征的患者，选择RDP可能是明智的。
The most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive surgery has been increasingly used in pancreatectomy. Initial results in robotic distal pancreatectomy (RDP) have been encouraging. Nonetheless, data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare. The aim of this study was to compare the safety and efficacy of RDP and LDP for PNETs. From September 2010 to January 2017, operative parameters and perioperative outcomes in an initial experience with 43 consecutive patients undergoing RDP were collected and compared with those in 31 patients undergoing LDP. Patients undergoing RDP and LDP demonstrated equivalent age, sex, ASA score, tumor location and tumor size. Operating time, length of resected pancreas, postoperative length of hospital stay and rates of conversion to open, pancreatic fistula, transfusion and reoperation were not statistically different. Patients in the RDP group were associated with significantly higher overall (79.1 vs. 48.4 %, P = 0.006) and Kimura spleen preservation rates (72.1 vs. 16.1%, P < 0.001) and had reduced risk of excessive blood loss (50 vs. 200mL, P < 0.001). Oncological outcomes in this series were superior for the RDP group with more lymph node harvest for G2 and G3 PNETs (3.5 vs. 2, P = 0.034). Both RDP and LDP are efficacious and safe methods in treating PNETs located in the body or tail of pancreas. Robotic approach offers advantages with less intraoperative blood loss, higher spleen preservation rate and more lymph node harvest. It may be sensible to choose RDP for patients who fit indications for scheduled spleen preservation.