Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China.
School of Medicine, Nankai University, Tianjin, China.
Surg Endosc. 2022 Nov;36(11):8237-8248. doi: 10.1007/s00464-022-09271-1. Epub 2022 May 9.
Pancreatoduodenectomy is the only potentially curative treatment for distal cholangiocarcinoma (DCC). In this study, we sought to compare the perioperative and oncological outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) based on a multicenter propensity score-matched study.
Consecutive patients with DCC who underwent RPD or OPD from five centers in China between January 2014 and June 2019 were included. A 1:1 propensity score matching (PSM) was performed. Univariable and multivariable Cox regression analyses were used to identify independent prognosis factors for overall survival (OS) and recurrence-free survival (RFS) of these patients.
A total of 217 patients and 228 patients underwent RPD and OPD, respectively. After PSM, 180 patients in each group were enrolled. There were no significant differences in operative time, lymph node harvest, intraoperative transfusion, vascular resection, R0 resection, postoperative major morbidity, reoperation, 90-day mortality, and long-term survival between the two groups before and after PSM. Whereas, compared with the OPD group, the RPD group had significantly lower estimated blood loss (150.0 ml vs. 250.0 ml; P < 0.001), and a shorter postoperative length of stay (LOS) (12.0 days vs. 15.0 days; P < 0.001). Multivariable analysis showed carbohydrate antigen 19-9 (CA19-9), R0 resection, N stage, perineural invasion, and tumor differentiation significantly associated with OS and RFS of these patients.
RPD was comparable to OPD in feasibility and safety. For patients with DCC, RPD resulted in similar oncologic and survival outcomes as OPD.
胰十二指肠切除术是治疗远端胆管癌（DCC）的唯一潜在治愈性治疗方法。本研究旨在基于多中心倾向评分匹配研究比较机器人胰十二指肠切除术（RPD）和开腹胰十二指肠切除术（OPD）的围手术期和肿瘤学结果。
连续纳入 2014 年 1 月至 2019 年 6 月期间在中国五家中心接受 RPD 或 OPD 的 DCC 患者。进行了 1:1 倾向评分匹配（PSM）。使用单变量和多变量 Cox 回归分析来确定这些患者总体生存（OS）和无复发生存（RFS）的独立预后因素。
共 217 例患者接受 RPD，228 例患者接受 OPD。PSM 后，每组各纳入 180 例患者。在 PSM 前后，两组患者的手术时间、淋巴结清扫、术中输血、血管切除、R0 切除、术后主要并发症、再次手术、90 天死亡率和长期生存情况无显著差异。然而，与 OPD 组相比，RPD 组的估计出血量明显较少（150.0ml 比 250.0ml；P<0.001），术后住院时间更短（12.0 天比 15.0 天；P<0.001）。多变量分析显示，碳水化合物抗原 19-9（CA19-9）、R0 切除、N 分期、神经周围侵犯和肿瘤分化与这些患者的 OS 和 RFS 显著相关。
RPD 在可行性和安全性方面与 OPD 相当。对于 DCC 患者，RPD 与 OPD 相比，肿瘤学和生存结果相似。
