Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, 60612, United States.
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, 60612, United States.
Surg Oncol. 2022 May;41:101736. doi: 10.1016/j.suronc.2022.101736. Epub 2022 Mar 4.
Centrally located pancreatic lesions are often treated with extended pancreaticoduodenectomy or distal pancreatectomy resulting in loss of healthy parenchyma and a high risk of diabetes and exocrine insufficiency. Robotic central pancreatectomy (RCP) is a parenchyma sparring alternative that has been shown safe and feasible [1,2].
In this article, we describe our operative technique and the perioperative outcomes of a series of RCP for low-grade or benign pancreatic tumors.
Six patients (5 female and 1 man) with a median age of 51.5 (44-68) years underwent a RCP for 2 serous cystadenomas, 2 mucinous cystic tumors, 1 neuroendocrine tumor, and 1 autoimmune pancreatitis. There were no conversions, intraoperative complications, or perioperative transfusions. Median operative time and was 240 (230-291) minutes and median blood loss was 100 (100-400) ml. The median hospital stay was 8 (5-27) days. There were no mortalities, reoperations, or readmissions. One patient developed a grade B pancreatic fistula which was successfully managed conservatively. All resections had free margins and the median tumor size was 2.5 (1.5-3.5) cm. After a mean follow-up of 46 months, no patients presented new-onset diabetes or exocrine insufficiency.
RCP represents the least invasive option for both the patient and the pancreatic parenchyma. With a standardized technique, RCP results in low postoperative morbidity and excellent long-term pancreatic function. Although our results are excellent, POPF still represents the main complication of central pancreatectomy with an incidence ranging from 0 to 80% depending on multiple factors such as the surgeon, technique, and pancreatic texture.
中央型胰腺病变常采用扩大胰十二指肠切除术或胰体尾切除术治疗，这会导致健康胰腺实质的损失，增加糖尿病和外分泌功能不全的风险。机器人辅助中央胰腺切除术（RCP）是一种保留胰腺实质的替代方法，已被证明是安全可行的[1,2]。
本文介绍了我们对一系列低级别或良性胰腺肿瘤行 RCP 的手术技术和围手术期结果。
6 名患者（5 名女性和 1 名男性），中位年龄为 51.5 岁（44-68 岁），因 2 例浆液性囊腺瘤、2 例黏液性囊性肿瘤、1 例神经内分泌肿瘤和 1 例自身免疫性胰腺炎而行 RCP。无中转开腹、术中并发症或围手术期输血。中位手术时间为 240 分钟（230-291 分钟），中位出血量为 100ml（100-400ml）。中位住院时间为 8 天（5-27 天）。无死亡、再次手术或再入院。1 例患者发生 B 级胰瘘，经保守治疗成功。所有切除均有切缘无肿瘤残留，肿瘤中位大小为 2.5cm（1.5-3.5cm）。平均随访 46 个月后，无患者新发糖尿病或外分泌功能不全。
RCP 是对患者和胰腺实质最微创的选择。采用标准化技术，RCP 术后并发症发病率低，长期胰腺功能良好。虽然我们的结果优异，但 POPF 仍然是中央胰腺切除术的主要并发症，其发生率因手术医生、技术和胰腺质地等多种因素而异，范围为 0 至 80%。
