Robotic pancreaticoduodenectomy may offer improved oncologic outcomes over open surgery: a propensity-matched single-institution study
Robotic pancreaticoduodenectomy may offer improved oncologic outcomes over open surgery: a propensity-matched single-institution study
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DOI：
10.1007/s00464-020-07564-x
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发表时间：
2020-04-23
影响因子：
3.1
通讯作者：
Martinie, John B.
中科院分区：
文献类型：
--
作者：
Baimas-George, Maria;Watson, Michael;Martinie, John B.
背景 胰腺疾病机器人平台因其在技术上比传统开放和腹腔镜技术具有显着优势而在肝胆界广受欢迎。尽管初步研究很有希望，但关于机器人胰十二指肠切除术（RPD）治疗胰腺癌的手术和肿瘤学结果的文献仍然很少。方法回顾性评估了 2008 年至 2019 年在一家三级机构进行的所有胰腺腺癌 RPD。 RPD 病例与开放病例 (OPD) 通过人口统计学和肿瘤学特征进行匹配，并使用 Mann-Whitney U 检验、对数秩检验和 Kaplan-Meier 方法进行比较。结果 38 例 RPD 病例与 38 例 OPD 相匹配。 RPD 的淋巴结 (LN) 产量显着更高（21.5 vs 13.5；p = 0.0036），并且手术时间或估计失血量 (EBL) 没有差异。 RPD 的胃排空延迟 (DGE) 率显着较低（3% vs 32%；p = 0.0009），但在胃漏、感染、出血、尿潴留或肠梗阻方面没有差异。 RPD 的住院时间 (LOS) 显着缩短（7.5 比 9；p = 0.0209）。 30 天或 90 天的再入院率或 90 天的死亡率没有差异。 R0 切除率和 LN 阳性率相当。 RPD 中位总生存期有改善的趋势（30.4 个月与 23.0 个月；p = 0.1105），并且复发时间更长（402 天与 284 天；p = 0.7471）。 OPD 的局部复发率是其两倍（16% vs. 8%），但远处复发率没有差异。结论 虽然 RPD 的可行性和安全性已得到证明，但其对肿瘤结果的影响仍有待研究。我们证明，RPD 不仅通过降低 DGE 提供类似的（即使不是更好的）术后立即获益，而且更重要的是可以提供改善的肿瘤学结果。机器人手术中证明的显着更高的 LN 产量和减少的炎症反应可能会提高总体生存率。
Background The robotic platform in pancreatic disease has gained popularity in the hepatobiliary community due to significant advantages it technically offers over conventional open and laparoscopic techniques. Despite promising initial studies, there remains scant literature on operative and oncologic outcomes of robotic pancreaticoduodenectomy (RPD) for pancreatic adenocarcinoma. Methods A retrospective review evaluated all RPD performed for pancreatic adenocarcinoma from 2008 to 2019 in a single tertiary institution. RPD cases were matched to open cases (OPD) by demographic and oncologic characteristics and outcomes compared using Mann-Whitney U test, log rank tests, and Kaplan-Meier methods. Results Thirty-eight RPD cases were matched to 38 OPD. RPD had significantly higher lymph node (LN) yield (21.5 vs 13.5; p = 0.0036) and no difference in operative time or estimated blood loss (EBL). RPD had significantly lower rate of delayed gastric emptying (DGE) (3% vs 32%; p = 0.0009) but no difference in leaks, infections, hemorrhage, urinary retention ,or ileus. RPD had significantly shorter length of stay (LOS) (7.5 vs. 9; p = 0.0209). There were no differences in 30- or 90-day readmissions or 90-day mortality. There was an equivalent R0 resection rate and LN positivity ratio. There was a trend towards improved median overall survival in RPD (30.4 vs. 23.0 months; p = 0.1105) and longer time to recurrence (402 vs. 284 days; p = 0.7471). OPD had two times the local recurrent rate (16% vs. 8%) but no difference in distant recurrence. Conclusions While the feasibility and safety of RPD has been demonstrated, the impact on oncologic outcomes had yet to be investigated. We demonstrate that RPD not only offers similar if not superior immediate post-operative benefit by decreasing DGE but more importantly may offer improved oncologic outcomes. The significantly higher LN yield and decreased inflammatory response demonstrated in robotic surgery may improve overall survival.