背景:微创胰十二指肠切除术治疗胰腺癌的证据有限。
方法:这项回顾性分析评估了2016年4月至2023年4月接受机器人胰十二指肠切除术(RPD)或腹腔镜胰十二指肠切除术(LPD)的患者。他们的基线和围手术期数据,包括手术时间,R0切除率,和严重的并发症发生率,被分析,和后续数据,如无病生存期(DFS)和总生存期(OS),被收集。
结果:共进行了253例LPD和RPD,包括101例胰腺癌,其中54例为LPD,47例为RPD。转化率(4.3%与29.6%,p=0.001)和失血(400vs.575mL,p<0.05)在RPD组中较低。两组手术时间差异无统计学意义,血管切除率,和TNM分期诊断;然而,R0切除率(80.9%vs.70.4%)和淋巴结收获(24.2vs.21.9)在RPD组中有更高的趋势,RPD队列的术后住院时间较短(11vs.13天)。此外,提高了1至3年的DFS(75.7%,61.7%,和36.0%vs.59.0%,35.6%,和21.9%)和OS(94.7%,84.7%,和50.8%与84.1%,63.6%,与LPD组相比,RPD组为45.5%)。
结论:与LPD相比,RPD在手术安全性和肿瘤结局方面具有优势,但围手术期结局与后者相似.长期结果需要进一步研究。
BACKGROUND: Evidence is limited for the treatment of pancreatic cancer among minimally invasive pancreatoduodenectomy.
METHODS: This retrospective analysis evaluated patients who underwent robotic pancreaticoduodenectomy (RPD) or laparoscopic pancreaticoduodenectomy (LPD) from April 2016 to April 2023. Their baseline and perioperative data, including operative time, R0 resection rates, and severe complications rates, were analyzed, and the follow-up data, such as disease-free survival (DFS) and overall survival (OS), were collected.
RESULTS: A total of 253 cases of LPD and RPD were performed, and 101 cases with pancreatic cancer were included, of which 54 were LPD and 47 were RPD. The conversion rate (4.3% vs. 29.6%, p = 0.001) and blood loss (400 vs. 575 mL, p < 0.05) were lower in the RPD group. No significant difference was observed between the two groups in terms of operative time, vessel resection rates, and TNM-stage diagnosis; however, R0 resection rates (80.9% vs. 70.4%) and lymph node harvest (24.2 vs. 21.9) had a higher tendency in the RPD group, and postoperative length of stay was shorter in the RPD cohort (11 vs. 13 days). Moreover, improved 1- to 3-years DFS (75.7%, 61.7%, and 36.0% vs. 59.0%, 35.6%, and 21.9%) and OS (94.7%, 84.7%, and 50.8% vs. 84.1%, 63.6%, and 45.5%) was found in the RPD group in comparison with the LPD group.
CONCLUSIONS: RPD had advantages in surgical safety and oncological outcomes compared with LPD, but was similar to the latter in perioperative outcomes. Long-term outcomes require further study.