Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, 201 Section 2 Shipai Road, Taipei, 112, Taiwan.
Surg Endosc. 2022 Feb;36(2):1507-1514. doi: 10.1007/s00464-021-08437-7. Epub 2021 Mar 26.
This study is to clarify the feasibility of and justification for robotic pancreaticoduodenectomy (RPD) in patients with pancreatic adenocarcinoma.
A 1-to-1 propensity score-matched comparison of RPD and open pancreaticoduodenectomy (OPD) was performed based on six covariates commonly used to predict the survival outcome for pancreatic adenocarcinoma.
A total of 130 patients were enrolled, with 65 in each study group after propensity score matching. The median operating time was longer for RPD (8.3 h vs. 7.0 h, P = 0.002). However, RPD was associated with less blood loss, lower overall surgical complication rate, and lower incidence of delayed gastric emptying. The resection radicality was oncologically similar between these two groups, but the median lymph node yield was higher for RPD (18 vs. 16, P = 0.038). Before propensity score matching, the 5-year survival was better in RPD (27.0% vs. 17.6%, P = 0.006). After matching, there was still a trend towards improved overall survival in the RPD group; however, the difference in 5-year survival between RPD and OPD was not significant (24.5% vs. 19.7%, P = 0.088).
RPD is not only technically feasible with no increase in surgical risk but also oncologically justifiable without compromising survival outcome. However, unlike randomized control trials, the limitations in this propensity score-matched analysis only accounted for 6 observed covariates commonly used to predict the survival outcome in patients with pancreatic adenocarcinoma, and confounders not included in this study could also affect our results.
本研究旨在阐明机器人胰十二指肠切除术（RPD）在胰腺腺癌患者中的可行性和合理性。
基于 6 个常用于预测胰腺腺癌生存结果的协变量，对 RPD 和开放胰十二指肠切除术（OPD）进行了 1:1 的倾向评分匹配比较。
共纳入 130 例患者，匹配后每组 65 例。RPD 的中位手术时间更长（8.3 小时比 7.0 小时，P=0.002）。然而，RPD 与出血量较少、总体手术并发症发生率较低和胃排空延迟发生率较低相关。两组的切除根治性在肿瘤学上相似，但 RPD 的中位淋巴结产量更高（18 比 16，P=0.038）。在进行倾向评分匹配之前，RPD 的 5 年生存率更好（27.0%比 17.6%，P=0.006）。匹配后，RPD 组的总生存率仍有改善趋势；然而，RPD 和 OPD 之间的 5 年生存率差异无统计学意义（24.5%比 19.7%，P=0.088）。
RPD 不仅在技术上可行，且不会增加手术风险，而且在肿瘤学上也是合理的，不会影响生存结果。然而，与随机对照试验不同，这种倾向评分匹配分析的局限性仅考虑了 6 个常用于预测胰腺腺癌患者生存结果的观察性协变量，而本研究未包括的混杂因素也可能影响我们的结果。
