Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD, 21287, USA.
Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
J Gastrointest Surg. 2021 Jul;25(7):1795-1804. doi: 10.1007/s11605-020-04869-z. Epub 2020 Nov 17.
Robotic pancreaticoduodenectomy is slowly gaining acceptance within pancreatic surgery. Advantages have been demonstrated for robotic surgery in other fields, but robust data for pancreaticoduodenectomy is limited. The aim of this study was to compare the short-term outcomes of robotic pancreaticoduodenectomy (RPD) to open pancreaticoduodenectomy (OPD) and laparoscopic pancreaticoduodenectomy (LPD).
Patients who underwent a pancreaticoduodenectomy between January 2011 and July 2019 at the Johns Hopkins Hospital were included in this retrospective propensity-matched analysis. The RPD cohort was matched to patients who underwent OPD in a 1:2 fashion and LPD in a 1:1 fashion. Short-term outcomes were analyzed for all three cohorts.
In total, 1644 patients were included, of which 96 (5.8%) underwent RPD, 131 (8.0%) LPD, and 1417 (86.2%) OPD. RPD was associated with a decreased incidence of delayed gastric emptying (9.4%) compared to OPD (23.5%; P = 0.006). The median estimated blood loss was significantly less in the RPD cohort (RPD vs OPD, 150 vs 487 mL; P < 0.001, RPD vs LPD, 125 vs 300 mL; P < 0.001). Compared to OPD, the robotic approach was associated with a shorter median length of stay (median 8 vs 9 days; P = 0.014) and a decrease in wound complications (4.2% vs 16.7%; P = 0.002). The incidence of other postoperative complications was comparable between RPD and OPD, and RPD and LPD.
In the hands of experienced surgeons, RPD may have a modest yet statistically significant reduction in estimated blood loss, postoperative length of stay, wound complications, and delayed gastric emptying comparing to OPD in similar patients.
机器人胰十二指肠切除术在胰腺外科领域逐渐得到认可。机器人手术在其他领域的优势已得到证实，但胰十二指肠切除术的相关数据仍有限。本研究旨在比较机器人胰十二指肠切除术（RPD）与开腹胰十二指肠切除术（OPD）和腹腔镜胰十二指肠切除术（LPD）的短期结果。
回顾性倾向评分匹配分析纳入 2011 年 1 月至 2019 年 7 月期间在约翰霍普金斯医院接受胰十二指肠切除术的患者。RPD 组与 OPD 患者按 1:2 比例匹配，与 LPD 患者按 1:1 比例匹配。对所有三组患者的短期结果进行分析。
共纳入 1644 例患者，其中 96 例（5.8%）接受 RPD，131 例（8.0%）接受 LPD，1417 例（86.2%）接受 OPD。RPD 术后胃排空延迟的发生率（9.4%）明显低于 OPD（23.5%；P=0.006）。RPD 组的估计失血量明显少于 OPD 组（RPD 与 OPD 相比，150 与 487ml；P<0.001，RPD 与 LPD 相比，125 与 300ml；P<0.001）。与 OPD 相比，机器人手术与较短的中位住院时间（中位数 8 与 9 天；P=0.014）和减少伤口并发症（4.2%与 16.7%；P=0.002）相关。RPD 与 OPD 和 RPD 与 LPD 的其他术后并发症发生率相似。
在经验丰富的外科医生手中，与 OPD 相比，RPD 可能在相似患者中具有适度但具有统计学意义的估计失血量、术后住院时间、伤口并发症和胃排空延迟减少。
