Esposito A, Casetti L, De Pastena M, Ramera M, Montagnini G, Landoni L, Bassi C, Salvia R
Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy.
Updates Surg. 2021 Jun;73(3):923-928. doi: 10.1007/s13304-020-00731-8. Epub 2020 Mar 11.
The minimally invasive approach in spleen-preserving distal pancreatectomy has currently been emphasized in benign and pre-malignant pancreatic diseases. The study aims to demonstrate the safety and feasibility of our technique of robotic spleen-preserving distal pancreatectomy (RSPDP) by a stepwise approach.
The data of consecutive patients presented for RSPDP from 2014 to 2019 at Verona University were retrieved from a prospectively maintained database. The patients were divided into two groups based on the surgical procedure performed, such as Kimura's (KG) or Warshaw's (WG) technique, and then compared.
In the study period, 32 patients underwent RSPDP. Twenty-three patients presented for the Kimura procedure (72%), while nine patients underwent the Warshaw procedure (28%). A higher body mass index was found in the KG (26 ± 4 vs. 22 ± 3, p = 0.037). Regarding the pathological data, the WG group differed in the tumor dimension, and the lymph nodes harvested (30 ± 2 vs. 17 ± 10, 9 ± 5 vs. 3 ± 4, p = 0.0028, and p = 0.005, respectively). Notably, no conversions and mortality were recorded. The overall morbidity was 25% ( eight patients) with no difference between the groups (p = 0.820). The mean length of stay was 8 days, and was similar between the groups (p = 0.350).
The present study suggests that RSPDP is a valid option for the treatment of benign or pre-malignant pancreatic diseases of the distal pancreas, with comparable morbidity with the standard treatment and no mortality. Further research is needed to standardize the technique and to assess the immunological, surgical, and financial benefits of the procedure.
目前，保留脾脏的微创远端胰腺切除术在良性及癌前胰腺疾病的治疗中备受关注。本研究旨在通过逐步操作的方法，论证我们的机器人保留脾脏远端胰腺切除术（RSPDP）技术的安全性和可行性。
从维罗纳大学一个前瞻性维护的数据库中检索2014年至2019年接受RSPDP的连续患者的数据。根据所实施的手术方式，如木村法（KG）或沃肖法（WG），将患者分为两组，然后进行比较。
在研究期间，32例患者接受了RSPDP。23例患者采用木村术式（72%），而9例患者接受了沃肖术式（28%）。KG组患者的体重指数较高（26±4 vs. 22±3，p = 0.037）。关于病理数据，WG组在肿瘤大小和切除的淋巴结数量方面存在差异（分别为30±2 vs. 17±10，9±5 vs. 3±4，p = 0.0028和p = 0.005）。值得注意的是，未记录到中转手术和死亡病例。总体发病率为25%（8例患者），两组之间无差异（p = 0.820）。平均住院时间为8天，两组之间相似（p = 0.350）。
本研究表明，RSPDP是治疗远端胰腺良性或癌前胰腺疾病的有效选择，其发病率与标准治疗相当，且无死亡病例。需要进一步研究以规范该技术，并评估该手术在免疫、手术及经济方面的益处。
