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机器人辅助胆囊癌切除术:单中心回顾性对比开放性切除术的研究。

Robotic Resection of Gallbladder Cancer: A Single-Center Retrospective Comparative Study to Open Resection.

机构信息

Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.

Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

出版信息

Am Surg. 2023 Apr;89(4):888-896. doi: 10.1177/00031348211047491. Epub 2021 Oct 15.

Abstract

BACKGROUND

Minimally invasive surgery is gaining support for resection of gallbladder cancer (GBC). This study aims to compare operative and early outcomes of robotic resection (RR) to open resection (OR) from a single institution performing a high volume of robotic HPB surgery.

METHODS

Twenty patients with GBC underwent RR from January 2013 to August 2019. Outcomes were compared to a historical control of 23 patients with OR. Radical cholecystectomy for suspected GBC and completion operations for incidental GBC after routine cholecystectomy were both included.

RESULTS

Robotic resection had lower blood loss compared to OR (150 vs 350 mL, = .002) and shorter postoperative length of stay (2.5 vs 6 days, < .001), while median operative time was similar (193 vs 208 min, = .604). There were no statistical differences in 30-day major complications or readmissions. No 30-day mortalities occurred. There was no statistical difference in survival trend ( = .438) or median lymph node harvest (5 vs 3, = .189) for RR compared to OR.

CONCLUSION

Robotic resection of GBC is safe and efficient, with lower length of hospital stay and blood loss compared to OR. Technical benefits of robotic-assisted surgery may prove advantageous though larger studies are still needed.

摘要

背景

微创外科技术越来越多地被应用于胆囊癌(GBC)的切除。本研究旨在比较同一机构中机器人辅助切除术(RR)与开放切除术(OR)在手术和早期结果方面的差异,该机构具有丰富的机器人肝胆手术经验。

方法

2013 年 1 月至 2019 年 8 月,20 例 GBC 患者接受了 RR,结果与 23 例 OR 患者的历史对照进行了比较。包括疑似 GBC 的根治性胆囊切除术和常规胆囊切除术后意外 GBC 的完成手术。

结果

RR 组的出血量明显少于 OR 组(150 毫升 vs 350 毫升,P =.002),术后住院时间也明显缩短(2.5 天 vs 6 天,P <.001),而手术时间中位数相似(193 分钟 vs 208 分钟,P =.604)。两组患者术后 30 天的主要并发症或再入院率无统计学差异。两组均无 30 天内死亡病例。RR 组与 OR 组的生存趋势(P =.438)或中位淋巴结清扫数量(5 枚 vs 3 枚,P =.189)均无统计学差异。

结论

RR 治疗 GBC 是安全有效的,与 OR 相比,RR 具有住院时间短、出血量少的优点。机器人辅助手术的技术优势可能具有优势,但仍需要更大规模的研究。

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