Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Surg Endosc. 2020 Feb;34(2):544-550. doi: 10.1007/s00464-019-06792-0. Epub 2019 Apr 23.
Data-driven patient selection guidelines are not available to optimize outcomes in minimally invasive pancreaticoduodenectomy (MIPD). We aimed to define risk factors associated with conversion from MIPD to open PD and to determine the impact of conversion on post-operative outcomes.
We conducted a retrospective review of MIPD using NSQIP from 2014 to 2015. Propensity score was used to match patients who underwent completed MIPD to converted MIPD.
467 patients were included: 375 (80.3%) MIPD and 92 (19.7%) converted. Converted patients were more often male (64% vs. 52%, p = 0.030), had higher rates of dyspnea (10% vs. 3%, p = 0.009), underwent more vascular (44% vs. 14%, p < 0.001) or multivisceral resection (19% vs. 6%, p = 0.0005), and were more likely attempted laparoscopically compared to robotically (76% vs. 51%, p < 0.001). Robotic approach was independently associated with reduced risk of conversion (OR 0.40, 95% CI 0.23-0.69), while male gender (OR 1.70, 95% CI 1.02-2.84), history of dyspnea (OR 3.85, 95% CI 1.49-9.96), vascular resection (OR 4.32, 95% CI 2.53-7.37), and multivisceral resection (OR 2.18, 95% CI 1.05-4.52) were associated with increased risk. Major complications were more common in converted patients (68% vs. 37%, p < 0.001). Converted patients had increased odds of non-home discharge (OR 3.25, 95% CI 1.06-9.97) and an associated increased length of stay of 3 days (95% CI 0.1-6.7).
Patients with a history of dyspnea or tumors requiring vascular or multivisceral resection were at increased risk of conversion, and the robotic platform was associated with a lower rate of conversion. Conversion was independently associated with increased overall complications, increased length of stay, and non-home discharge.
目前尚无数据驱动的患者选择指南来优化微创胰十二指肠切除术（MIPD）的结果。我们旨在确定与从 MIPD 转为开腹 PD 相关的危险因素，并确定转化对术后结果的影响。
我们使用 NSQIP 对 2014 年至 2015 年期间进行的 MIPD 进行了回顾性分析。采用倾向评分法将接受完整 MIPD 的患者与转为 MIPD 的患者进行匹配。
共纳入 467 例患者：375 例（80.3%）为 MIPD，92 例（19.7%）转为 MIPD。转为 MIPD 的患者中，男性比例更高（64%比 52%，p=0.030），呼吸困难发生率更高（10%比 3%，p=0.009），接受血管（44%比 14%，p<0.001）或多脏器切除（19%比 6%，p=0.0005）的比例更高，且更倾向于接受腹腔镜手术而非机器人手术（76%比 51%，p<0.001）。机器人手术方式独立降低了转化风险（OR 0.40，95%CI 0.23-0.69），而男性（OR 1.70，95%CI 1.02-2.84）、呼吸困难史（OR 3.85，95%CI 1.49-9.96）、血管切除（OR 4.32，95%CI 2.53-7.37）和多脏器切除（OR 2.18，95%CI 1.05-4.52）与增加转化风险相关。转化患者的主要并发症更为常见（68%比 37%，p<0.001）。转化患者非居家出院的几率更高（OR 3.25，95%CI 1.06-9.97），且住院时间延长 3 天（95%CI 0.1-6.7）。
有呼吸困难史或需要血管或多脏器切除的肿瘤患者转化风险增加，机器人平台与较低的转化率相关。转化与整体并发症增加、住院时间延长和非居家出院独立相关。
