Rosemurgy Alexander S, Ross Sharona B, Espeut Abigail, Nguyen Danielle, Crespo Kaitlyn, Syblis Cameron, Vasanthakumar Padma, Sucandy Iswanto
From the Digestive Health Institute, Tampa, FL.
J Am Coll Surg. 2022 Apr 1;234(4):677-684. doi: 10.1097/XCS.0000000000000137.
Robotic surgery is a burgeoning minimally invasive approach to pancreaticoduodenectomy. This study was undertaken to compare survival after robotic vs "open" pancreaticoduodenectomy for ductal adenocarcinoma using propensity score-matched patients.
With institutional review board approval, we prospectively followed 521 patients who underwent robotic (n = 311) or open (n = 210) pancreaticoduodenectomy. Patients who underwent robotic (n = 75) or open (n = 75) pancreaticoduodenectomy were propensity score-matched by age, sex, and American Joint Committee on Cancer stage. Neoadjuvant therapy was rarely administered, and adjuvant therapy was stressed (FOLFIRINOX for patients <70 years of age and gemcitabine + nab-paclitaxel for patients >70 years of age). Data are presented as median (mean ± SD).
Operative duration was longer and estimated blood loss and length of stay were less with robotic pancreaticoduodenectomy (421 [409 ± 94.0] vs 267 [254 ± 81.2] minutes; 307 [(150 ± 605.3] vs 444 [255 ± 353.1] mL; 7 [5 ± 5.1] vs 11 [8 ± 9.5] days; p < 0.00001 for all). There were no differences in complications (Clavien-Dindo class ≥III, p = 0.30), in-hospital mortality (p = 0.61), or 30-day readmission rates (p = 0.19). Median survival after robotic vs open pancreaticoduodenectomy was 37 vs 24 months (p = 0.08). For propensity score-matched patients, operative duration for robotic pancreaticoduodenectomy was longer (442 [438 ± 117.7] vs 261 [249 ± 67.1] minutes) and estimated blood loss was less (269 [200 ± 296.1] vs 468 [300 ± 394.9] mL), as was length of stay (7 [5 ± 5.1] vs 10 [7 ± 8.6] days; p < 0.00001 for all). There were no differences in complication rates (Clavien-Dindo class ≥ III, p = 0.31) or in-hospital mortality (p = 0.40); 30-day readmissions were fewer after robotic pancreaticoduodenectomy (7% vs 20%, p = 0.03). Median survival for the robotic vs the open approach was 41 vs 17 months (p = 0.02).
Patients that underwent robotic pancreaticoduodenectomy had longer operations, less estimated blood loss, shorter length of stay, and fewer 30-day readmissions; they lived much longer than patients who underwent open pancreaticoduodenectomy. We believe that robotic pancreaticoduodenectomy provides salutary and survival benefits for reasons yet unknown.
机器人手术是一种新兴的微创胰十二指肠切除术方法。本研究旨在使用倾向评分匹配的患者比较机器人辅助与“开放”胰十二指肠切除术治疗导管腺癌后的生存率。
经机构审查委员会批准，我们前瞻性地随访了521例行机器人辅助（n = 311）或开放（n = 210）胰十二指肠切除术的患者。对行机器人辅助（n = 75）或开放（n = 75）胰十二指肠切除术的患者，根据年龄、性别和美国癌症联合委员会分期进行倾向评分匹配。新辅助治疗很少应用，强调辅助治疗（年龄<70岁的患者采用FOLFIRINOX方案，年龄>70岁的患者采用吉西他滨+纳米白蛋白结合型紫杉醇方案）。数据以中位数（均值±标准差）表示。
机器人辅助胰十二指肠切除术的手术时间更长，但估计失血量和住院时间更少（421[409±94.0]分钟对267[254±81.2]分钟；307[150±605.3]毫升对444[255±353.1]毫升；7[5±5.1]天对11[8±9.5]天；所有p<0.00001）。并发症（Clavien-Dindo分级≥III级，p = 0.30）、住院死亡率（p = 0.61）或30天再入院率（p = 0.19）无差异。机器人辅助与开放胰十二指肠切除术后的中位生存期分别为37个月和24个月（p = 0.08）。对于倾向评分匹配的患者，机器人辅助胰十二指肠切除术的手术时间更长（442[438±117.7]分钟对261[249±67.1]分钟），估计失血量更少（269[200±296.1]毫升对468[300±394.9]毫升），住院时间也更少（7[5±5.1]天对10[7±8.6]天；所有p<0.00001）。并发症发生率（Clavien-Dindo分级≥III级，p = 0.31）或住院死亡率（p = 0.40）无差异；机器人辅助胰十二指肠切除术后30天再入院率更低（7%对20%，p = 0.03）。机器人辅助与开放手术方式的中位生存期分别为41个月和17个月（p = 0.02）。
接受机器人辅助胰十二指肠切除术的患者手术时间更长，估计失血量更少，住院时间更短，30天再入院率更低；他们的生存时间比接受开放胰十二指肠切除术的患者长得多。我们认为，机器人辅助胰十二指肠切除术能带来有益和生存益处，原因尚不清楚。
