Sanchinarro University Hospital, Madrid, Spain.
General Surgery Department, San Pablo University, CEU, Madrid, Spain.
Int J Med Robot. 2022 Oct;18(5):e2425. doi: 10.1002/rcs.2425. Epub 2022 May 28.
Enucleation has widely spread as an alternative strategy in the treatment of small pancreatic tumours and cystic lesions. To date there are limited data on perioperative outcomes after pancreatic enucleation performed using a minimally invasive robotic technique, particularly regarding the risk factors associated with postoperative pancreatic fistula (POPF). We perform a comparative study of robotic pancreatic enucleation (RPE) and open enucleation (OPE) with the aim of evaluating clinical and cost-effective outcomes.
This is a case-matched analysis of patients who underwent robotic and open pancreatic enucleation performed at Sanchinarro University Hospital, Madrid, from October 2014 to December 2021. Patient data were obtained retrospectively. Clinicopathologic characteristics and perioperative and postoperative outcomes were recorded and analysed. Two groups of demographically similar patients were analysed: the robotic group (n = 20) and the open group (n = 20). The patient characteristics of the two groups have been compared. From February 2015, quality-adjusted life years (QALYs) are also included and prospectively recorded in the database and used to measure the effectiveness of the treatment.
A total of 20 RPE and 20 OPE have been included. The incremental cost of the robotic approach versus open was €2617.85(CI 95% 1601.48; 3634.24) and the incremental utility was 0.0879 QALYs (CI 95% 0.0834; 0.0925). The estimated ICER for patients was €29,782.13 (CI 95% 17,313.29; 43,576.01) per QALY gained. Robotic resection resulted a shorter postoperative hospital stay, less wound infections, faster recovery diet and a similar operating time. The two groups had similar complication rates. Pathological data were similar for both procedures.
RPE resulted in a shorter hospital stay and less blood loss and morbidity, comparable with the outcomes of open enucleation. RPE may also be acceptable in terms of cost-effectiveness.
作为一种替代策略，在治疗小胰腺肿瘤和囊性病变时，广泛采用了胰腺切除术。迄今为止，关于使用微创机器人技术进行胰腺切除术的围手术期结果的数据有限，特别是与术后胰瘘（POPF）相关的风险因素。我们进行了一项机器人胰腺切除术（RPE）和开放胰腺切除术（OPE）的对比研究，旨在评估临床和经济有效的结果。
这是一项回顾性病例匹配分析，纳入了 2014 年 10 月至 2021 年 12 月在马德里 Sanchinarro 大学医院接受机器人和开放胰腺切除术的患者。收集患者数据。记录并分析临床病理特征以及围手术期和术后结果。对两组具有相似人口统计学特征的患者进行了分析：机器人组（n=20）和开放组（n=20）。比较了两组患者的特征。自 2015 年 2 月起，还纳入了质量调整生命年（QALY）并在数据库中进行前瞻性记录，用于衡量治疗效果。
共纳入 20 例 RPE 和 20 例 OPE。与开放手术相比，机器人手术的增量成本为 2617.85 欧元（95%CI 1601.48；3634.24），增量效用为 0.0879 QALY（95%CI 0.0834；0.0925）。患者的估计 ICER 为每获得一个 QALY 需花费 29782.13 欧元（95%CI 17313.29；43576.01）。机器人切除术术后住院时间更短，伤口感染更少，恢复饮食更快，手术时间相似。两组并发症发生率相似。两种手术的病理数据相似。
RPE 可缩短住院时间和减少出血量及发病率，与开放胰腺切除术的结果相当。RPE 在成本效益方面也可能是可接受的。
