Najafi Nawid, Mintziras I, Wiese D, Albers M B, Maurer E, Bartsch D K
Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
Surg Today. 2020 Aug;50(8):872-880. doi: 10.1007/s00595-020-01966-z. Epub 2020 Feb 3.
The present study aimed to compare robotic-assisted versus laparoscopic distal pancreatic resection and enucleation for potentially benign pancreatic neoplasms.
Patients were retrieved from a prospectively maintained database. Demographic data, tumor types, and the perioperative outcomes were retrospectively analyzed.
In a 10-year period, 75 patients (female, n = 44; male, n = 31; median age, 53 years [range, 9-84 years]) were identified. The majority of patients had pancreatic neuroendocrine neoplasms (n = 39, 52%) and cystic neoplasms (n = 23, 31%) with a median tumor size of 17 (3-60) mm. Nineteen (25.3%) patients underwent enucleation (robotic, n = 11; laparoscopic, n = 8) and 56 (74.7%) patients underwent distal pancreatic resection (robotic, n = 24; laparoscopic, n = 32), of those 48 (85%) underwent spleen-preserving procedures. Eight (10.7%) procedures had to be converted to open surgery. The rate of vessel preservation in distal pancreatectomy was significantly higher in robotic-assisted procedures (62.5% vs. 12.5%, p = 0.01). Twenty-six (34.6%) patients experienced postoperative complications (Clavien-Dindo grade > 3). Twenty (26.7%) patients developed a pancreatic fistula type B. There was no mortality. After a median follow-up period of 58 months (range 2-120 months), one patient (1.3%) developed local recurrence (glucagonoma) after enucleation, which was treated with a Whipple procedure.
The robotic approach is comparably safe, but increases the rate of splenic vessel preservation and reduces the risk of conversion to open surgery.
本研究旨在比较机器人辅助与腹腔镜下远端胰腺切除术及摘除术治疗潜在良性胰腺肿瘤的效果。
从一个前瞻性维护的数据库中检索患者。对人口统计学数据、肿瘤类型和围手术期结果进行回顾性分析。
在10年期间，共确定了75例患者（女性44例，男性31例；中位年龄53岁[范围9 - 84岁]）。大多数患者患有胰腺神经内分泌肿瘤（39例，52%）和囊性肿瘤（23例，31%），肿瘤中位大小为17（3 - 60）mm。19例（25.3%）患者接受了摘除术（机器人手术11例，腹腔镜手术8例），56例（74.7%）患者接受了远端胰腺切除术（机器人手术24例，腹腔镜手术32例），其中48例（85%）接受了保脾手术。8例（10.7%）手术不得不转为开放手术。机器人辅助手术在远端胰腺切除术中的血管保留率显著更高（62.5%对12.5%，p = 0.01）。26例（34.6%）患者出现术后并发症（Clavien - Dindo分级>3级）。20例（26.7%）患者发生B型胰瘘。无死亡病例。中位随访期58个月（范围2 - 120个月）后，1例（1.3%）患者在摘除术后出现局部复发（胰高血糖素瘤），接受了惠普尔手术治疗。
机器人手术方法同样安全，但提高了脾血管保留率，降低了转为开放手术的风险。
