Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
J Gastrointest Surg. 2013 May;17(5):1002-8. doi: 10.1007/s11605-012-2137-6. Epub 2013 Jan 17.
Central pancreatectomy is a definitive treatment for low-grade tumors of the pancreatic neck that preserves pancreatic and splenic function at the potential expense of postoperative pancreatic fistula. We analyzed outcomes after robot-assisted central pancreatectomy (RACP) to reexamine the risk-benefit profile in the era of minimally invasive surgery.
Retrospective analysis of nine RACP performed between August 2009 through June 2010 at a single institution.
The average age of the cohort was 64 (range 18-75 years) with six women (67 %). Indications for surgery included: five benign cystic neoplasm and four pancreatic neuroendocrine tumor. Median operative time was 425 min (range 305-506 min) with 190 ml median blood loss (range 50-350 ml) and one conversion to open due to poor visualization. Median tumor size was 3.0 cm (range 1.9-6.0 cm); all patients achieved R0 status. Pancreaticogastrostomy was performed in seven cases and pancreaticojejunostomy in two. The median length of hospital stay was 10 days (range 7-19). Two clinically significant pancreatic fistulae occurred with one requiring percutaneous drainage. No patients exhibited worsening diabetes or exocrine insufficiency at the 30-day postoperative visit.
RACP can be performed with safety and oncologic outcomes equivalent to published open series. Although the rate of pancreatic fistula was high, only 22 % had clinically significant events, and none developed worsening pancreatic endocrine or exocrine dysfunction.
胰颈肿瘤低度恶性，行保留胰脾的胰颈肿瘤切除术可保留胰腺和脾脏功能，但术后可能发生胰瘘。我们分析了机器人辅助胰颈肿瘤切除术（RACP）的结果，旨在重新评估微创时代的风险效益比。
对单中心 2009 年 8 月至 2010 年 6 月期间进行的 9 例 RACP 进行回顾性分析。
患者平均年龄为 64 岁（18-75 岁），女性 6 例（67%）。手术指征包括：5 例良性囊性肿瘤和 4 例胰腺神经内分泌肿瘤。中位手术时间为 425 分钟（305-506 分钟），中位出血量 190ml（50-350ml），1 例因视野不佳转为开腹。肿瘤中位大小为 3.0cm（1.9-6.0cm）；所有患者均达到 R0 状态。7 例行胰胃吻合，2 例行胰肠吻合。中位住院时间为 10 天（7-19 天）。2 例发生临床显著胰瘘，其中 1 例需要经皮引流。术后 30 天，无患者出现糖尿病恶化或外分泌功能不全。
RACP 可安全进行，且肿瘤学结果与已发表的开放系列相当。虽然胰瘘发生率较高，但仅 22%的患者发生临床显著胰瘘，且无一例发生胰腺内分泌或外分泌功能恶化。
