Rosemurgy Alexander S, Luberice Kenneth, Krill Emily, Castro Miguel, Espineira Gabriel Rivera, Sucandy Iswanto, Ross Sharona
AdvenHealth Tampa, Digestive Health Institute, Tampa, FL, USA.
Am Surg. 2020 Aug;86(8):958-964. doi: 10.1177/0003134820942181. Epub 2020 Aug 11.
This study was undertaken to examine 100 consecutive robotic distal pancreatectomies with splenectomies, and to compare our outcomes to predicted outcomes as calculated using the American college of surgeons national surgical quality improvement program (ACS NSQIP) Surgical Risk Calculator and to the outcomes contained within NSQIP.
Outcomes were compared with predicted outcomes, calculated using the ACS NSQIP Surgical Risk Calculator, and with outcomes documented in NSQIP for distal pancreatectomy. For illustrative purposes, data are presented as median (mean ± SD).
Patients who underwent robotic distal pancreatectomy were of age 67 (63 ± 13.4) years with a BMI of 29 (29 ± 6.3) kg/m, with 49% being women. Operative duration was 242 (265 ± 112.2) minutes and estimated blood loss was 110 (211 ± 233.9) mL. Predicted outcomes were similar to those reported in NSQIP. Our actual outcomes were significantly superior to the predicted outcomes for serious complication, any complication, surgical site infection, sepsis, and length of stay. Compared to NSQIP outcomes, our actual outcomes for serious complication, any complication, surgical site infection, sepsis, and delayed gastric emptying were significantly superior. Twelve percent of operations were converted to "open." There were 3 deaths within 30 days, similar to predicted outcomes. Deaths were due to sepsis (2) and respiratory failure (1).
Our patients' predicted outcomes were the same as national outcomes; our patients were not a select group. However, their actual outcomes were like or significantly superior than those predicted by NSQIP or reported in NSQIP. We believe that the robot has the future of distal pancreatectomy with or without splenectomy.
本研究旨在对连续100例机器人辅助远端胰腺切除术联合脾切除术进行分析，并将我们的手术结果与使用美国外科医师学会国家外科质量改进计划（ACS NSQIP）手术风险计算器计算出的预测结果以及NSQIP中包含的结果进行比较。
将手术结果与使用ACS NSQIP手术风险计算器计算出的预测结果以及NSQIP中记录的远端胰腺切除术结果进行比较。为便于说明，数据以中位数（均值±标准差）表示。
接受机器人辅助远端胰腺切除术的患者年龄为67（63±13.4）岁，体重指数为29（29±6.3）kg/m²，女性占49%。手术时间为242（265±112.2）分钟，估计失血量为110（211±233.9）毫升。预测结果与NSQIP中报告的结果相似。我们的实际结果在严重并发症、任何并发症、手术部位感染、脓毒症和住院时间方面显著优于预测结果。与NSQIP结果相比，我们在严重并发症、任何并发症、手术部位感染、脓毒症和胃排空延迟方面的实际结果显著更优。12%的手术转为“开放手术”。30天内有3例死亡，与预测结果相似。死亡原因是脓毒症（2例）和呼吸衰竭（1例）。
我们患者的预测结果与全国结果相同；我们的患者并非特殊群体。然而，他们的实际结果与NSQIP预测的结果或NSQIP报告的结果相当或显著更优。我们认为机器人技术在有或无脾切除的远端胰腺切除术中具有未来前景。
