Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study
Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study
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DOI：
10.1002/jso.24676
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发表时间：
2017-09-15
影响因子：
2.5
通讯作者：
Zhao, Guo-Dong
中科院分区：
文献类型：
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作者：
Liu, Rong;Liu, Qu;Zhao, Guo-Dong
机器人远端胰腺切除术(RDP)被认为是一种安全可行的替代腹腔镜远端胰腺切除术(LDP)的手术方式。然而，以往的研究存在样本量小、选择偏向等局限性。本研究旨在评价机器人手术在远端胰腺切除术中的优势。方法回顾了2011年1月至2015年12月接受RDP(n=102)和LDP(n=102)手术的患者的人口统计学特征和围手术期结局。结果两组患者在围手术期的手术时间、出血量、输血率、总的并发症和胰瘘发生率等方面均无显著差异。机器人手术降低了中转开腹率(2.9%比9.8%，P=0.045)，尤其是大肿瘤患者(0%比22.2%，P=0.042)。中度肿瘤患者的脾和脾血管保留率(60.0%vs 35.5%，P=0.047；37.1%vs 12.9%，P=0.025)，尤其是非恶性肿瘤患者(95.5%vs 52.4%，P=0.001；59.1%vs 19.0%，P=0.007)。术后住院天数显著减少(7.67%vs8.58，P=0.032)。结论RDP较LDP中转开腹率低，术后PHS短，SP和SVP发生率高。
BackgroundRobotic distal pancreatectomy (RDP) is considered a safe and feasible alternative to laparoscopic distal pancreatectomy (LDP). However, previous studies have some limitations including small sample size and selection bias. This study aimed to evaluate whether the robotic approach has advantages over laparoscopic surgery in distal pancreatectomy.MethodsDemographics and perioperative outcomes among patients undergoing RDP (n=102) and LDP (n=102) between January 2011 and December 2015 were reviewed. A 1:1 propensity score matched analysis was performed between both groups.ResultsBoth groups displayed no significant differences in perioperative outcomes including operative time, blood loss, transfusion rate, and rates of overall morbidities and pancreatic fistula. Robotic approach reduced the rate of conversion to laparotomy (2.9% vs 9.8%, P=0.045), especially in patients with large tumors (0% vs 22.2%, P=0.042). RDP improved spleen (SP) and splenic vessels preservation (SVP) rates in patients with moderate tumors (60.0% vs 35.5%, P=0.047; 37.1% vs 12.9%, P=0.025), especially in patients without malignancy (95.5% vs 52.4%, P=0.001; 59.1% vs 19.0%, P=0.007). RDP also reduced postoperative hospital stay (PHS) significantly (7.67% vs 8.58, P=0.032).ConclusionsRDP is associated with less rate of conversion to laparotomy, shorter PHS, and improved SP and SVP rates in selected patients than LDP.