Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
The Ohio State University, Division of Surgical Oncology, Columbus, OH.
Ann Surg. 2021 May 1;273(5):966-972. doi: 10.1097/SLA.0000000000003550.
This study aims to present the outcomes of our decade-long experience of robotic pancreatoduodenectomy and provide insights into successful program implementation.
Despite significant improvement in mortality over the past 30 years, morbidity following open pancreatoduodenectomy remains high. We implemented a minimally invasive pancreatic surgery program based on the robotic platform as one potential method of improving outcomes for this operation.
A retrospective review of a prospectively maintained institutional database was performed to identify patients who underwent robotic pancreatoduodenectomy (RPD) between 2008 and 2017 at the University of Pittsburgh.
In total, 500 consecutive RPDs were included. Operative time, conversion to open, blood loss, and clinically relevant postoperative pancreatic fistula improved early in the experience and have remained low despite increasing complexity of case selection as reflected by increasing number of patients with pancreatic cancer, vascular resections, and higher Charlson Comorbidity scores (all P<0.05). Operating room time plateaued after 240 cases at a median time of 391 minutes (interquartile rang 340-477). Major complications (Clavien >2) occurred in less than 24%, clinically relevant postoperative pancreatic fistula in 7.8%, 30- and 90-day mortality were 1.4% and 3.1% respectively, and median length of stay was 8 days. Outcomes were not impacted by integration of trainees or expansion of selection criteria.
Structured implementation of robotic pancreatoduodenectomy can be associated with excellent outcomes. In the largest series of RPD, we establish benchmarks for the surgical community to consider when adopting this approach.
本研究旨在展示我们长达十年的机器人胰十二指肠切除术经验的结果，并深入了解成功实施该项目的经验。
尽管过去 30 年来死亡率有了显著改善，但开腹胰十二指肠切除术的发病率仍然很高。我们实施了一项基于机器人平台的微创胰腺手术计划，作为改善该手术结果的潜在方法之一。
对匹兹堡大学 2008 年至 2017 年间接受机器人胰十二指肠切除术（RPD）的患者进行前瞻性维护机构数据库的回顾性分析。
共纳入 500 例连续的 RPD。手术时间、中转开腹、出血量和术后临床相关胰瘘均在早期得到改善，并且尽管随着患者胰腺恶性肿瘤、血管切除和更高的 Charlson 合并症评分（均 P<0.05）等病例选择复杂性的增加，手术复杂性增加，但仍保持较低水平。手术时间在 240 例后达到平台期，中位数为 391 分钟（四分位距 340-477）。主要并发症（Clavien>2）发生率低于 24%，临床相关术后胰瘘发生率为 7.8%，30 天和 90 天死亡率分别为 1.4%和 3.1%，中位住院时间为 8 天。培训生的整合或选择标准的扩大并未影响结果。
机器人胰十二指肠切除术的结构化实施可以带来优异的结果。在最大的 RPD 系列中，我们为采用这种方法的外科医生建立了基准。
