Liu Rong, Liu Qu, Zhao Zhi-Ming, Tan Xiang-Long, Gao Yuan-Xing, Zhao Guo-Dong
Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Department of General Surgery, Tianjin, China.
J Surg Oncol. 2017 Sep;116(4):461-469. doi: 10.1002/jso.24676. Epub 2017 Jun 19.
Robotic distal pancreatectomy (RDP) is considered a safe and feasible alternative to laparoscopic distal pancreatectomy (LDP). However, previous studies have some limitations including small sample size and selection bias. This study aimed to evaluate whether the robotic approach has advantages over laparoscopic surgery in distal pancreatectomy.
Demographics and perioperative outcomes among patients undergoing RDP (n = 102) and LDP (n = 102) between January 2011 and December 2015 were reviewed. A 1:1 propensity score matched analysis was performed between both groups.
Both groups displayed no significant differences in perioperative outcomes including operative time, blood loss, transfusion rate, and rates of overall morbidities and pancreatic fistula. Robotic approach reduced the rate of conversion to laparotomy (2.9% vs 9.8%, P = 0.045), especially in patients with large tumors (0% vs 22.2%, P = 0.042). RDP improved spleen (SP) and splenic vessels preservation (SVP) rates in patients with moderate tumors (60.0% vs 35.5%, P = 0.047; 37.1% vs 12.9%, P = 0.025), especially in patients without malignancy (95.5% vs 52.4%, P = 0.001; 59.1% vs 19.0%, P = 0.007). RDP also reduced postoperative hospital stay (PHS) significantly (7.67% vs 8.58, P = 0.032).
RDP is associated with less rate of conversion to laparotomy, shorter PHS, and improved SP and SVP rates in selected patients than LDP.
机器人辅助远端胰腺切除术（RDP）被认为是腹腔镜远端胰腺切除术（LDP）的一种安全可行的替代方法。然而，以往的研究存在一些局限性，包括样本量小和选择偏倚。本研究旨在评估机器人手术在远端胰腺切除术中是否比腹腔镜手术具有优势。
回顾了2011年1月至2015年12月期间接受RDP（n = 102）和LDP（n = 102）的患者的人口统计学和围手术期结果。两组之间进行了1:1倾向评分匹配分析。
两组在围手术期结果方面无显著差异，包括手术时间、失血量、输血率以及总体并发症和胰瘘发生率。机器人手术方法降低了中转开腹率（2.9%对9.8%，P = 0.045），尤其是在肿瘤较大的患者中（0%对22.2%，P = 0.042）。RDP提高了中度肿瘤患者的脾脏（SP）和脾血管保留（SVP）率（60.0%对35.5%，P = 0.047；37.1%对12.9%，P = 0.025），尤其是在无恶性肿瘤的患者中（95.5%对52.4%，P = 0.001；59.1%对19.0%，P = 0.007）。RDP还显著缩短了术后住院时间（PHS）（7.67天对8.58天，P = 0.032）。
与LDP相比，RDP在特定患者中转开腹率更低、PHS更短，且SP和SVP率更高。
