机器人辅助与开放胰十二指肠切除术治疗胰腺导管腺癌的肿瘤学结果：倾向评分匹配分析。
Oncological outcomes of robotic-assisted versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score-matched analysis.
机构信息
Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Huangpu District, Shanghai, 200025, China.
出版信息
Surg Endosc. 2021 Jul;35(7):3437-3448. doi: 10.1007/s00464-020-07791-2. Epub 2020 Jul 21.
BACKGROUND
Robotic-assisted minimally invasive surgery is associated with worse oncologic outcomes for some but not other types of cancers. We conducted a propensity score-matched analysis to compare oncologic outcomes of robotic-assisted laparoscopic (RPD) vs. open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC).
METHODS
Treatment-naïve PDAC patients undergoing either RPD or OPD at our hospital between January 2013 and December 2017 were included. Propensity score matching was conducted at a ratio of 1:2. The primary outcome was disease-free survival (DFS) and overall survival (OS).
RESULTS
A total of 672 cases were identified. The propensity score-matched cohort included 105 patients receiving RPD and 210 patients receiving OPD. The 2 groups did not differ in the number of retrieved lymph nodes [11 (7-16) vs. 11 (6-17), P = 0.622] and R0 resection rate (88.6% vs. 89.0%, P = 0.899). There was no statistically significant difference in median DFS (14 [95% CI 11-22] vs. 12 [95% CI 10-14] months (HR 0.94; 95% CI 0.87-1.50; log-rank P = 0.345) and median OS (27 [95% CI 22-35] vs. 20 [95% CI 18-24] months (HR 0.77; 95% CI 0.57-1.04; log-rank P = 0.087) between the two groups. Multivariate COX analysis showed that RPD was not an independent predictor of DFS (HR 0.90; 95% CI 0.68-1.19, P = 0.456) or OS (HR 0.77; 95% CI 0.57-1.05, P = 0.094).
CONCLUSION
Comparable DFS and OS were observed between patients receiving RPD and OPD. This preliminary finding requires further confirmation with prospective randomized controlled trials.
背景
机器人辅助微创手术与某些类型的癌症相关，但与其他类型的癌症的肿瘤学结果较差。我们进行了倾向评分匹配分析，以比较机器人辅助腹腔镜（RPD）与开放胰十二指肠切除术（OPD）治疗胰腺导管腺癌（PDAC）的肿瘤学结果。
方法
我们纳入了 2013 年 1 月至 2017 年 12 月期间在我院接受 RPD 或 OPD 的治疗初治 PDAC 患者。采用 1:2 的比例进行倾向评分匹配。主要结局是无病生存期（DFS）和总生存期（OS）。
结果
共确定了 672 例患者。在倾向评分匹配队列中，有 105 例患者接受了 RPD 治疗，210 例患者接受了 OPD 治疗。两组淋巴结清扫数量[11（7-16）与 11（6-17），P=0.622]和 R0 切除率（88.6%与 89.0%，P=0.899）无差异。DFS 中位数无统计学差异（14 [95%CI 11-22]与 12 [95%CI 10-14]个月（HR 0.94；95%CI 0.87-1.50；对数秩 P=0.345）和 OS 中位数无统计学差异（27 [95%CI 22-35]与 20 [95%CI 18-24]个月（HR 0.77；95%CI 0.57-1.04；对数秩 P=0.087）。多变量 COX 分析表明，RPD 不是 DFS（HR 0.90；95%CI 0.68-1.19，P=0.456）或 OS（HR 0.77；95%CI 0.57-1.05，P=0.094）的独立预测因子。
结论
接受 RPD 和 OPD 的患者的 DFS 和 OS 相似。这一初步发现需要前瞻性随机对照试验进一步证实。
Zotero 插件