Rodriguez Maylis, Memeo Riccardo, Leon Piera, Panaro Fabrizio, Tzedakis Stylianos, Perotto Ornella, Varatharajah Sharmini, de'Angelis Nicola, Riva Pietro, Mutter Didier, Navarro Francis, Marescaux Jacques, Pessaux Patrick
General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France.
Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD)/Research Institute against Digestive Cancer, Strasbourg, France.
Hepatobiliary Surg Nutr. 2018 Oct;7(5):345-352. doi: 10.21037/hbsn.2018.09.03.
The aim of this study was to analyze the clinical and economic impact of robotic distal pancreatectomy, laparoscopic distal pancreatectomy, and open distal pancreatectomy.
All consecutive patients who underwent distal pancreatic resection for benign and malignant diseases between January 2012 and December 2015 were prospectively included. Cost analysis was performed; all charges from patient admission to discharge were considered.
There were 21 robotic (RDP), 25 laparoscopic (LDP), and 43 open (ODP) procedures. Operative time was longer in the RDP group (RDP =345 minutes, LDP =306 min, ODP =251 min, P=0.01). Blood loss was higher in the ODP group (RDP =192 mL, LDP =356 mL, ODP =573 mL, P=0.0002). Spleen preservation was more frequent in the RDP group (RDP =66.6%, LDP =61.9%, ODP =9.3%, P=0.001). The rate of patients with Clavien-Dindo > grade III was higher in the ODP group (RDP =0%, LDP =12%, ODP =23%, P=0.01), especially for non-surgical complications, which were more frequent in the ODP group (RDP =9.5%, LDP =24%, ODP =41.8%, P=0.02). Length of hospital stay was increased in the ODP group (ODP =19 days, LDP =13 days, RDP =11 days, P=0.007). The total cost of the procedure, including the surgical procedure and postoperative course was higher in the ODP group (ODP =30,929 Euros, LDP =22,150 Euros, RDP =21,219 Euros, P=0.02).
Cost-effective results of RDP seem to be similar to LDP with some better short-term outcomes.
本研究旨在分析机器人辅助远端胰腺切除术、腹腔镜远端胰腺切除术和开放远端胰腺切除术的临床及经济影响。
前瞻性纳入2012年1月至2015年12月期间因良性和恶性疾病接受远端胰腺切除术的所有连续患者。进行成本分析；考虑从患者入院到出院的所有费用。
共进行了21例机器人辅助手术（RDP）、25例腹腔镜手术（LDP）和43例开放手术（ODP）。RDP组手术时间更长（RDP = 345分钟，LDP = 306分钟，ODP = 251分钟，P = 0.01）。ODP组失血量更高（RDP = 192毫升，LDP = 356毫升，ODP = 573毫升，P = 0.0002）。RDP组保脾率更高（RDP = 66.6%，LDP = 61.9%，ODP = 9.3%，P = 0.001）。ODP组Clavien-Dindo分级>Ⅲ级的患者比例更高（RDP = 0%，LDP = 12%，ODP = 23%，P = 0.01），尤其是非手术并发症，在ODP组更常见（RDP = 9.5%，LDP = 24%，ODP = 41.8%，P = 0.02）。ODP组住院时间延长（ODP = 19天，LDP = 13天，RDP = 11天，P = 0.007）。ODP组手术总费用，包括手术过程和术后疗程更高（ODP = 30929欧元，LDP = 22150欧元，RDP = 21219欧元，P = 0.02）。
机器人辅助远端胰腺切除术的成本效益结果似乎与腹腔镜远端胰腺切除术相似，且短期结局更好。
