机器人辅助胰头十二指肠切除术在胰腺癌中的应用：手术效果的评估与分析

Robotic Versus Laparoscopic Pancreaticoduodenectomy for Pancreatic Cancer: Evaluation and Analysis of Surgical Efficacy

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ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2024 Oct

作者: Menghua Dai, Lixin Chen, Qiang Xu, Ming Cui, Pengyu Li, Wenjing Liu, Chen Lin, Weijie Chen, Haomin Chen, Shuai Yuan

DOI: 10.1245/s10434-024-15764-1

摘要

关于微创胰头十二指肠切除术治疗胰腺癌的文献资料有限。本回顾性分析评估了2016年4月至2023年4月期间接受机器人胰头十二指肠切除术（RPD）或腹腔镜胰头十二指肠切除术（LPD）的患者，比较其基础信息和围手术期指标，包括手术时间、R0切除率及严重并发症发生率，并收集随访数据，如无病生存期（DFS）及总生存期（OS）。共完成253例腹腔镜和机器人手术，其中包括54例胰腺癌患者（LPD54例，RPD47例）。结果显示，RPD的转换率（4.3% vs. 29.6%，p=0.001）和出血量（400 mL vs. 575 mL，p<0.05）明显低于LPD组。两组在手术时间、血管切除率及TNM分期诊断方面无显著差异，但R0切除率（80.9% vs. 70.4%）和淋巴结清扫数（24.2 vs. 21.9）倾向于更高，且RPD组术后住院时间更短（11天 vs. 13天）。此外，RPD组在1至3年无病生存率（75.7%、61.7%、36.0% vs. 59.0%、35.6%、21.9%）和总生存率（94.7%、84.7%、50.8% vs. 84.1%、63.6%、45.5%）方面优于LPD组。综上，RPD在手术安全性和肿瘤学预后方面优于LPD，但在围手术期结局方面表现相似。长期疗效仍需进一步研究。

Abstract

Evidence is limited for the treatment of pancreatic cancer among minimally invasive pancreatoduodenectomy.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.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.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.