背景:在十二指肠胃肠道间质瘤(DGIST)的微创手术治疗中积累了经验,但是在手术方法的选择上没有共识。
目的:总结机器人切除DGIST的技术和可行性。
方法:回顾性分析2010年5月1日至2020年5月1日连续一系列接受机器人切除和开放切除DGIST的患者的围手术期和人口统计学结果。将患者分为开放手术组和机器人手术组。根据肿瘤的位置以及肿瘤与十二指肠乳头之间的距离,进行了胰十二指肠切除术(PD)或有限切除。年龄,性别,肿瘤位置,肿瘤大小,操作时间(OT),估计失血量(EBL),术后住院时间(PHS),肿瘤有丝分裂,术后风险分类,比较两组患者术后复发和无复发生存率。
结果:在28例患者中,19名男性,9名女性,年龄51.3±13.1岁。17例患者进行了有限切除,11例患者进行了PD。11名患者接受了开放手术,17名患者接受了机器人手术。机器人手术组的两名患者接受了开放手术的转换。所有肿瘤均为R0切除,年龄没有显著差异,性别,肿瘤大小,操作模式,PHS,肿瘤有丝分裂,术后并发症的发生率,风险分类,两组患者术后靶向药物治疗或术后复发(P>0.05)。机器人组的OT、EBL与开放手术组比较差异有统计学意义(P<0.05)。所有患者在随访期间均存活,4例患者出现复发和转移。开放手术组与机器人手术组的无复发生存率差异无统计学意义(P>0.05)。
结论:机器人切除术对于DGIST患者是安全可行的,其治疗效果相当于开腹手术。
BACKGROUND: Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors (DGISTs) is accumulating, but there is no consensus on the choice of surgical method.
OBJECTIVE: To summarize the technique and feasibility of robotic resection of DGISTs.
METHODS: The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1, 2010 and May 1, 2020 were retrospectively analyzed. The patients were divided into the open surgery group and the robotic surgery group. Pancreatoduodenectomy (PD) or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla. Age, sex, tumour location, tumour size, operation time (OT), estimated blood loss (EBL), postoperative hospital stay (PHS), tumour mitosis, postoperative risk classification, postoperative recurrence and recurrence-free survival were compared between the two groups.
RESULTS: Of the 28 patients included, 19 were male and 9 were female aged 51.3 ± 13.1 years. Limited resection was performed in 17 patients, and PD was performed in 11 patients. Eleven patients underwent open surgery, and 17 patients underwent robotic surgery. Two patients in the robotic surgery group underwent conversion to open surgery. All the tumours were R0 resected, and there was no significant difference in age, sex, tumour size, operation mode, PHS, tumour mitosis, incidence of postoperative complications, risk classification, postoperative targeted drug therapy or postoperative recurrence between the two groups (P > 0.05). OT and EBL in the robotic group were significantly different to those in the open surgery group (P < 0.05). All the patients survived during the follow-up period, and 4 patients had recurrence and metastasis. No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group (P > 0.05).
CONCLUSIONS: Robotic resection is safe and feasible for patients with DGISTs, and its therapeutic effect is equivalent to open surgery.