机器人胰十二指肠切除术学习曲线和肿瘤学可行性评估：基于倾向评分的与开放手术比较。
Assessment of learning curve and oncologic feasibility of robotic pancreaticoduodenectomy: A propensity score-based comparison with open approach.
机构信息
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
Department of Clinical Epidemiology and Biostatics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
出版信息
J Hepatobiliary Pancreat Sci. 2022 Jun;29(6):649-658. doi: 10.1002/jhbp.837. Epub 2020 Nov 6.
BACKGROUND
Though robotic pancreaticoduodenectomy(R-PD) is gradually adopted, learning curve and its feasibility is still controversial. We analyzed our first 70 R-PD cases, comparing surgical outcomes and feasibility to those of open pancreaticoduodenectomy (O-PD).
METHODS
Medical records of 70 patients of R-PD and 269 patients of O-PD between 2015 and 2019 were retrospectively analyzed. Cumulative sum analysis was used to determine learning curve. Surgical outcomes were compared between early(1-35) and late cases(36-70). Additional analyses with O-PD using propensity score-matching were done.
RESULTS
Learning curve of R-PD completed after 30 cases. Shorter operative time, lower estimated blood loss, and shorter length of stay were noted in later cases. Complication rate tended to decrease over time. In comparison with O-PD after matching, R-PD showed longer operation time(414.5 minutes vs 244.7 minutes; P < .001), with no differences in estimated blood loss, or length of stay. While overall complication rate was higher in R-PD(45.5% vs 21.8%; P = .010), no statistically significant difference was observed in major complication rates(23.6% vs 10.9%; P = .084). R0 rate was equivalent.
CONCLUSION
Surgical performance of R-PD improved over time. Learning curve of R-PD completed after 30 cases. R-PD is a promising modality, based on comparison of perioperative and oncologic feasibilities to those of O-PD.
背景
尽管机器人胰十二指肠切除术（R-PD）逐渐被采用，但学习曲线及其可行性仍存在争议。我们分析了我们的前 70 例 R-PD 病例，将手术结果和可行性与开放胰十二指肠切除术（O-PD）进行了比较。
方法
回顾性分析了 2015 年至 2019 年间 70 例 R-PD 和 269 例 O-PD 患者的病历。采用累积和分析确定学习曲线。比较早期（1-35 例）和晚期（36-70 例）病例的手术结果。使用倾向评分匹配对 O-PD 进行了额外分析。
结果
R-PD 的学习曲线在完成 30 例后完成。晚期病例的手术时间更短、估计出血量更少、住院时间更短。并发症发生率随时间推移呈下降趋势。与匹配后的 O-PD 相比，R-PD 的手术时间更长（414.5 分钟比 244.7 分钟；P<.001），估计出血量和住院时间无差异。尽管 R-PD 的总体并发症发生率较高（45.5%比 21.8%；P=.010），但主要并发症发生率无统计学差异（23.6%比 10.9%；P=.084）。R0 率相等。
结论
R-PD 的手术表现随着时间的推移有所改善。R-PD 的学习曲线在完成 30 例后完成。基于与 O-PD 的围手术期和肿瘤学可行性比较，R-PD 是一种有前途的治疗方法。
Zotero 插件