Gavriilidis Paschalis, Lim Chetana, Menahem Benjamin, Lahat Eylon, Salloum Chady, Azoulay Daniel
Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; INSERM U 955, Créteil, France.
HPB (Oxford). 2016 Jul;18(7):567-74. doi: 10.1016/j.hpb.2016.04.008. Epub 2016 May 20.
Minimally invasive pancreaticoduodenectomy is considered hazardous for the majority of authors and minimally distal pancreatectomy is still a debated topic. The aim of this study was to compare robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP) using meta-analysis.
EMBASE, Medline and PubMed were searched systematically to identify full-text articles comparing robotic and laparoscopic distal pancreatectomies. The meta-analysis was performed by using Review Manager 5.3.
Nine studies fulfilled the inclusion criteria and included 637 patients (246 robotic and 391 laparoscopic). RDP had a shorter hospital length of stay by 1 day (P = 0.01). On the other hand, LDP had shorter operative time by 30 min, although this was statistically nonsignificant (P = 0.12). RDP showed a significantly increased readmission rate (P = 0.04). There was no difference in the conversion rate, incidence of postoperative pancreatic fistula, International Study Group of Pancreatic Fistula grade B-C rate, major morbidity, spleen preservation rate and perioperative mortality. All surgical specimens of RDP reported R0 negative margins, whereas 7 specimens in the LDP group had affected margins.
In terms of feasibility, safety and oncological adequacy, there is no essential difference between the two techniques so far. The 30 min longer operative time of the RDP is due to the docking and undocking of the robot. The shorter length of stay by 1 day should be judged in combination with the increased 90-day readmission rate.
对于大多数作者而言，微创胰十二指肠切除术被认为具有危险性，而微创远端胰腺切除术仍是一个存在争议的话题。本研究的目的是通过荟萃分析比较机器人辅助远端胰腺切除术（RDP）与腹腔镜远端胰腺切除术（LDP）。
系统检索EMBASE、Medline和PubMed以确定比较机器人辅助和腹腔镜远端胰腺切除术的全文文章。使用Review Manager 5.3进行荟萃分析。
9项研究符合纳入标准，共纳入637例患者（246例行机器人辅助手术，391例行腹腔镜手术）。RDP的住院时间缩短1天（P = 0.01）。另一方面，LDP的手术时间缩短30分钟，尽管这在统计学上无显著意义（P = 0.12）。RDP的再入院率显著增加（P = 0.04）。在中转率、术后胰瘘发生率、国际胰瘘研究组B - C级发生率、严重并发症、脾脏保留率和围手术期死亡率方面没有差异。RDP的所有手术标本均报告切缘R0阴性，而LDP组有7个标本切缘受累。
就可行性、安全性和肿瘤学充分性而言，到目前为止这两种技术之间没有本质区别。RDP手术时间长30分钟是由于机器人的对接和脱开。住院时间缩短1天应结合90天再入院率的增加来判断。
