Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Int J Surg. 2021 Jun;90:105960. doi: 10.1016/j.ijsu.2021.105960. Epub 2021 May 12.
Several studies have suggested an association between visceral obesity and adverse perioperative outcomes in pancreatic surgery. However, no study has reported the impact of visceral obesity on robotic pancreatic surgery. This study aimed to assess the impact of preoperative visceral obesity on clinically relevant postoperative pancreatic fistula (CR-POPF) in pancreatic ductal adenocarcinoma (PDAC) patients following robotic distal pancreatectomy (RDP) or open distal pancreatectomy (ODP).
A retrospective analysis was performed on all patients who consecutively underwent RDP or ODP for PDAC. The visceral adipose tissue was measured on preoperative computed tomography (CT) images at the L3 vertebra level. A 1:1 propensity score matching method was used in the visceral obesity group and the nonvisceral obesity group to minimize the bias between RDP and ODP.
Between December 2011 and December 2018, a total of 445 patients were included. Visceral obesity (n = 219) was found to be associated with higher estimated blood loss (p = 0.033), a higher CR-POPF rate (p = 0.001), delayed drain removal (p = 0.005) and a longer length of stay (p = 0.033). In multivariable analysis, visceral obesity was an independent risk factor for CR-POPF (OR: 1.69; 95% CI 1.07-2.67, p = 0.024). Among patients without visceral obesity, the incidence of CR-POPF was lower among RDP than among ODP patients (11.27% vs. 23.87%, p = 0.028), and the difference remained after propensity score matching (9.52% vs. 26.98%, p = 0.011). However, there was no significant difference in the CR-POPF rate between RDP and ODP for visceral obesity patients.
In nonvisceral obesity patients, RDP had better perioperative outcomes than ODP, with a significantly lower CR-POPF rate. However, in visceral obesity patients, RDP showed equivalent CR-POPF rate when compared to ODP.
几项研究表明，内脏肥胖与胰腺手术的围手术期不良结局之间存在关联。然而，尚无研究报道内脏肥胖对机器人胰腺手术的影响。本研究旨在评估术前内脏肥胖对机器人胰十二指肠切除术（RDP）或开放胰十二指肠切除术（ODP）治疗胰腺导管腺癌（PDAC）患者术后临床相关胰瘘（CR-POPF）的影响。
对连续接受 RDP 或 ODP 治疗 PDAC 的所有患者进行回顾性分析。在术前 CT 图像的 L3 椎体水平测量内脏脂肪组织。采用 1:1 倾向评分匹配方法在内脏肥胖组和非内脏肥胖组之间进行匹配，以最小化 RDP 和 ODP 之间的偏倚。
2011 年 12 月至 2018 年 12 月期间，共纳入 445 例患者。结果发现，内脏肥胖（n=219）与更高的估计出血量（p=0.033）、更高的 CR-POPF 发生率（p=0.001）、引流管拔除延迟（p=0.005）和住院时间延长（p=0.033）相关。多变量分析显示，内脏肥胖是 CR-POPF 的独立危险因素（OR：1.69；95%CI 1.07-2.67，p=0.024）。在无内脏肥胖的患者中，RDP 组的 CR-POPF 发生率低于 ODP 组（11.27%比 23.87%，p=0.028），且在倾向评分匹配后差异仍然存在（9.52%比 26.98%，p=0.011）。然而，对于内脏肥胖患者，RDP 和 ODP 之间的 CR-POPF 发生率无显著差异。
在非内脏肥胖患者中，RDP 具有更好的围手术期结局，CR-POPF 发生率显著降低。然而，对于内脏肥胖患者，RDP 与 ODP 相比，CR-POPF 发生率相当。
