Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK.
Br J Surg. 2021 Mar 12;108(2):188-195. doi: 10.1093/bjs/znaa039.
The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP.
A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien-Dindo grade IIIa or above).
A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004).
The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.
微创远端胰腺切除术的作用仍不明确，机器人辅助远端胰腺切除术（RDP）是否优于腹腔镜远端胰腺切除术（LDP）尚不清楚，因为缺乏大型多中心研究。本研究比较了 RDP 和 LDP 的围手术期结果。
一项多中心国际倾向评分匹配研究纳入了来自六个国家的 21 个欧洲中心的患者，这些中心每年至少进行 15 例远端胰腺切除术（2011 年 1 月至 2019 年 6 月），因任何原因接受 RDP 或 LDP 治疗。倾向评分匹配采用 1：1 比例基于术前特征。主要结局是主要发病率（Clavien-Dindo 分级 IIIa 或以上）。
共纳入 1551 例患者（407 例 RDP 和 1144 例 LDP）。RDP 组中 402 例患者与 LDP 组中 402 例患者进行匹配。匹配后，RDP 组和 LDP 组的主要发病率（分别为 14.2%和 16.5%；P=0.378）、术后胰瘘 B/C 级（分别为 24.6%和 26.5%；P=0.543）或 90 天死亡率（分别为 0.5%和 1.3%；P=0.268）无差异。RDP 组的手术时间长于 LDP 组（中位数 285（IQR 225-350）与 240（195-300）min；P<0.001），转化率较低（6.7%与 15.2%；P<0.001），脾保留率较高（81.4%与 62.9%；P=0.001），住院时间较长（中位数 8.5（IQR 7-12）与 7（6-10）天；P<0.001），再入院率较低（11.0%与 18.2%；P=0.004）。
RDP 和 LDP 的主要发病率无差异。RDP 与转化率、脾保留率和再入院率的提高相关，而手术时间和住院时间延长。
