Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study
Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study
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DOI：
10.1007/s00464-015-4140-y
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发表时间：
2015-12-01
影响因子：
3.1
通讯作者：
Li, Hong-Wei
中科院分区：
文献类型：
--
作者：
Chen, Shi;Chen, Jiang-Zhi;Li, Hong-Wei
机器人辅助腹腔镜胰十二指肠切除术是一种新型的微创手术技术，其对于边缘恶性或恶性疾病患者的有效性和安全性尚不清楚。本研究旨在前瞻性评估 RLPD 与开放性 PD (OPD) 的有效性和安全性。2010 年 1 月至 2013 年 12 月期间，180 名符合条件的患者因选择性 RLPD (n = 60) 或 OPD (n = 120) 前瞻性住院。他们在肿瘤位置、肿瘤类型、肿瘤大小、ASA 分类、年龄和性别方面进行了匹配。主要结局指标包括人口统计学、术中变量、发病率、术后恢复和中期评估。在研究期间，RLPD 组的手术时间显着更长但更短（中位 410 分钟 vs. 323 分钟；P < 0.001），失血量更少（中位 400 vs. 500 mL；P = 0.005），营养状况恢复更好，加速下床恢复活动（3.2与 OPD 组相比，排便恢复更快（3.6 天 vs. 5.2 天；P < 0.001），住院时间更短（20 天 vs. 25 天；P = 0.002）。两组的手术发病率和死亡率以及 R0 切除率和切除的淋巴结数量相似。在胰腺腺癌患者中，两组患者的总体生存率和无病生存率相似 (ACTRN12614000299606)。这项第一项规模最大的前瞻性匹配研究表明，对于治疗选定的交界性和恶性病变，RLPD 具有显着的学习曲线效应并加快术后恢复，但其手术和肿瘤学安全性与 OPD 相似。
Robot-assisted laparoscopic pancreaticoduodenectomy is a novel minimally invasive surgery technique, and its effectiveness and safety remain unknown in patients with borderline malignant or malignant diseases. This study aimed to prospectively evaluate the effectiveness and safety of RLPD versus open PD (OPD).Between January 2010 and December 2013, 180 eligible patients were prospectively hospitalized for elective RLPD (n = 60) or OPD (n = 120). They were matched for tumor location, tumor type, tumor size, ASA classification, age, and sex. The main outcome measures included demographics, intraoperative variables, morbidity, postoperative recovery, and mid-term evaluation.Over the study period, the RLPD group had a significantly longer but decreasing operative time (median 410 vs. 323 min; P < 0.001), less blood loss (median 400 vs. 500 mL; P = 0.005), better nutritional status recovery, expedited off-bed return to activity (3.2 vs. 4.8 d; P < 0.001), faster resumption of bowel movement (3.6 vs. 5.2 d; P < 0.001), and shorter hospital stay (20 vs. 25 d; P = 0.002) compared to the OPD group. The two groups had similar surgical morbidities and mortality as well as R0 resection rate and number of lymph nodes resected. Among patients with pancreatic adenocarcinoma, the two groups had similar overall and disease-free survival (ACTRN12614000299606).This first largest, prospective matched study demonstrated that for treating selected borderline and malignant pathologies, RLPD was associated with a significant learning curve effect and expedited postoperative recovery, but had a surgical and oncological safety profile similar to OPD.