Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
Updates Surg. 2021 Jun;73(3):967-975. doi: 10.1007/s13304-021-01037-z. Epub 2021 Apr 2.
Robotic central pancreatectomy has been applied for 20 years with the advantage of minimally invasive surgery. The general pancreatic reconstruction approaches include pancreaticojejunostomy and pancreaticogastrostomy. Recently, our group reported a few preliminary cases of application of end-to-end pancreatic anastomosis in robotic central pancreatectomy. This novel approach has not been compared with the conventional approach on a large scale. The objective of this study is to compare end-to-end pancreatic anastomosis with pancreaticojejunostomy after robotic central pancreatectomy based on the perioperative and long-term outcomes. Clinical data consist of demographics, clinicopathologic characteristics, perioperative and long-term outcomes of patients who underwent robotic central pancreatectomy from March 2015 to December 2019 were collected and analyzed. Seventy-four patients received a robotic central pancreatectomy with either end-to-end pancreatic anastomosis (n = 52) or pancreaticojejunostomy (n = 22). End-to-end pancreatic anastomosis was associated with shorter operative time and reduced blood loss. Despite a higher incidence of clinically relevant postoperative pancreatic fistula (69.2% vs. 36.4%, p = 0.009), the newer anastomotic technique was also associated with earlier removal of nasogastric tube and resumption of oral intake. Long-term results, in terms of either endocrine or exocrine function, were not affected by the anastomotic technique. We have shown the feasibility of robotic central pancreatectomy with end-to-end pancreatic anastomosis. Despite streamlined technique, the newer anastomosis appears to improve early post-operative results while preserving endocrine and exocrine functions in the long-term period. Evaluation of the true potential of robotic central pancreatectomy with end-to-end pancreatic anastomosis requires a prospective and randomized study enrolling a large number of patients.
机器人胰头切除术已经应用了 20 年，具有微创的优势。一般的胰腺重建方法包括胰肠吻合术和胰胃吻合术。最近，我们小组报告了几例机器人胰头切除术应用端端胰腺吻合术的初步病例。这种新方法尚未在大规模上与传统方法进行比较。本研究的目的是比较机器人胰头切除术中采用端端胰腺吻合术与胰肠吻合术的围手术期和长期结果。临床数据包括 2015 年 3 月至 2019 年 12 月接受机器人胰头切除术的患者的人口统计学、临床病理学特征、围手术期和长期结果。收集并分析了 74 例接受机器人胰头切除术的患者的临床资料，其中 52 例行端端胰腺吻合术，22 例行胰肠吻合术。端端胰腺吻合术与手术时间更短和出血量减少相关。尽管术后发生临床相关胰瘘的发生率较高（69.2%比 36.4%，p=0.009），但新的吻合技术也与更早拔除鼻胃管和恢复口服饮食有关。在评估内分泌或外分泌功能的长期结果方面，吻合技术没有影响。我们已经证明了机器人胰头切除术采用端端胰腺吻合术的可行性。尽管技术简化，但新的吻合似乎可以改善术后早期结果，同时在长期内保持内分泌和外分泌功能。要评估机器人胰头切除术采用端端胰腺吻合术的真正潜力，需要一项前瞻性、随机研究，纳入大量患者。
