Chen Shi, Zhan Qian, Chen Jiang-zhi, Jin Jia-bin, Deng Xia-xing, Chen Hao, Shen Bai-yong, Peng Cheng-hong, Li Hong-wei
Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
Surg Endosc. 2015 Dec;29(12):3507-18. doi: 10.1007/s00464-015-4101-5. Epub 2015 Mar 20.
Spleen preservation (SP) is beneficial for patients undergoing distal pancreatectomy of benign and borderline tumors; however, the conventional laparoscopy approach (C-LDP) is less effective in controlling splenic vessel bleeding. The benefits of the robotic-assisted approach (RA-LDP) in SP have not been clearly described. This study aimed to evaluate whether a robotic approach could improve SP rate and effectiveness/safety profile of laparoscopic distal pancreatectomy (LDP).
Matched for scheduled SP, age, sex, ASA classification, tumor size, tumor location, and pathological type, 69 patients undergoing RA-LDP and 50 undergoing C-LDP between January 2005 and May 2014 were included. Main outcome measures included SP rate, operative time (OT), blood loss, transfusion frequency, morbidity, postoperative hospital stay (PHS), and oncologic safety.
Among matched patients scheduled for SP, RA-LDP was associated with significantly higher overall (95.7 vs. 39.4%) and Kimura SP rates (72.3 vs. 21.2%), shorter OT (median 120 vs. 200 min), less blood loss (median 100 vs. 300 mL), lower transfusion frequency (2.1 vs. 18.2%), and shorter mean PHS (10.2 vs. 14.5 days). Among matched patients scheduled for splenectomy, RA-LDP was associated with similar OT, blood loss, transfusion frequency, and PHS. The two approaches were similar in overall morbidity, frequency of pancreatic fistula, and oncologic outcome among patients undergoing splenectomy for malignant tumors.
RA-LDP was associated with a significantly better SP rate and reduced OT, blood loss, transfusion requirement, and PHS for patients undergoing SP compared to C-LDP, but offered less benefits for patients undergoing splenectomy.
保留脾脏（SP）对接受良性和交界性肿瘤远端胰腺切除术的患者有益；然而，传统腹腔镜手术方法（C-LDP）在控制脾血管出血方面效果较差。机器人辅助手术方法（RA-LDP）在保留脾脏方面的优势尚未得到清晰描述。本研究旨在评估机器人手术方法能否提高腹腔镜远端胰腺切除术（LDP）的脾脏保留率及有效性/安全性。
纳入2005年1月至2014年5月期间计划进行保留脾脏手术、年龄、性别、美国麻醉医师协会（ASA）分级、肿瘤大小、肿瘤位置及病理类型相匹配的69例行RA-LDP的患者和50例行C-LDP的患者。主要观察指标包括脾脏保留率、手术时间（OT）、失血量、输血频率、发病率、术后住院时间（PHS）及肿瘤学安全性。
在计划进行保留脾脏手术的匹配患者中，RA-LDP的总体脾脏保留率（95.7%对39.4%）和木村式脾脏保留率（72.3%对21.2%）显著更高，手术时间更短（中位数120分钟对200分钟），失血量更少（中位数100毫升对300毫升），输血频率更低（2.1%对18.2%），平均术后住院时间更短（10.2天对14.5天）。在计划进行脾切除术的匹配患者中，RA-LDP的手术时间、失血量、输血频率及术后住院时间相似。两种手术方法在总体发病率、胰瘘发生率及恶性肿瘤脾切除患者的肿瘤学结局方面相似。
与C-LDP相比，RA-LDP在接受保留脾脏手术的患者中脾脏保留率显著更高，手术时间、失血量、输血需求及术后住院时间减少，但对接受脾切除术的患者益处较小。
