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腹腔镜和机器人手术切除胰腺癌。

Laparoscopic and robotic resection for pancreatic cancer.

机构信息

Mayo Clinic College of Medicine, Rochester, MN, USA.

出版信息

Cancer J. 2012 Nov-Dec;18(6):571-6. doi: 10.1097/PPO.0b013e31827b8f86.

Abstract

Minimally invasive surgical approaches for pancreatic resection have been established as feasible and safe. Whereas widespread application of laparoscopic distal pancreatectomy is in progress, the utilization of laparoscopic pancreaticoduodenectomy is still localized to a few centers because of the added complexity and advanced laparoscopic skills required. Comparative studies have demonstrated the typical advantages of minimally invasive approaches for pancreatic resection, namely, less blood loss and shorter hospital stay. Robotic assistance for laparoscopic approaches is gaining interest, but the true value added is still undefined. Significant discussion revolves around the appropriateness of minimally invasive approaches in pancreatic cancer. Although limited data and only short-term follow-up engender ongoing skepticism, the technical feasibility, existing reports in pancreatic cancer, and the lack of negative outcomes in other gastrointestinal cancers spark ongoing clinical evaluation. Minimally invasive surgical approaches have significant potential to improve the outcomes of pancreatic resection especially in pancreatic cancer patients in whom an optimal recovery is important for adjuvant treatment options. Larger experiences are forthcoming, and controlled trials are eagerly awaited; however, the feasibility of such is questionable because of the low incidence of resectable pancreatic cancer and the small number of centers performing minimally invasive pancreatectomy for malignancy.

摘要

微创外科手术方法在胰腺切除术中已被证明是可行和安全的。虽然腹腔镜胰体尾切除术已经广泛应用,但由于需要更高的复杂性和先进的腹腔镜技能,腹腔镜胰十二指肠切除术的应用仍然局限于少数中心。对比研究表明,微创胰腺切除术具有典型的优势,即出血量少,住院时间短。腹腔镜手术的机器人辅助技术越来越受到关注,但真正的附加值仍未确定。目前的讨论主要集中在微创方法在胰腺癌中的应用是否合适。尽管有限的数据和仅短期随访仍存在持续的怀疑,但技术的可行性、胰腺癌的现有报告以及其他胃肠道癌症中没有不良结果,激发了持续的临床评估。微创外科手术方法在胰腺切除术中具有显著的改善预后的潜力,特别是在胰腺癌患者中,对于辅助治疗方案来说,最佳的恢复非常重要。更大的经验即将到来,人们急切地等待着对照试验;然而,由于可切除性胰腺癌的发病率低,以及进行微创胰腺恶性肿瘤切除术的中心数量较少,因此此类试验的可行性值得怀疑。

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