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接受辅助化疗的胰腺癌患者行机器人胰腺切除术的肿瘤学结局:一项倾向评分匹配的回顾性队列研究。

Oncological outcomes of robotic pancreatectomy in patients with pancreatic cancer who receive adjuvant chemotherapy: A propensity score-matched retrospective cohort study.

机构信息

Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Royal Infirmary Edinburgh, UK.

出版信息

Int J Surg. 2022 Aug;104:106801. doi: 10.1016/j.ijsu.2022.106801. Epub 2022 Aug 5.

DOI:10.1016/j.ijsu.2022.106801
PMID:35934284
Abstract

BACKGROUND

Limited data are available regarding long-term oncological outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) who undergo robotic pancreatectomy (RP).

METHOD

All patients who underwent RP and open pancreatectomy (OP) for resectable PDAC between January 2011 and December 2019 were included. The RP group was matched 1:1 with OP group by propensity score matching (PSM). The oncological outcomes were collected and analyzed.

RESULTS

Overall, 1606 patients were included in this study. After PSM, a well-balanced cohort of 335 patients in each group was selected for further analysis. The RP group had shorter operative time (210 min vs. 240 min, P < 0.001), lower estimated blood loss (200 ml vs. 300 ml, P = 0.011), lower wound infection rates (4.5% vs. 10.1%, P = 0.005) and shorter length of postoperative hospital stay (15 days vs. 17 days, P = 0.001) compared to the OP group, with no significant differences in other perioperative outcomes. OS was comparable between the two groups (31 months vs. 28 months, P = 0.077); however, RFS was improved in the RP group (17 months vs. 14 months, P = 0.015). Subgroup analysis showed that patients who received adjuvant chemotherapy (AC) in the RP group had better RFS than the similar patient cohort in the OP group (17 months vs. 14 months, P = 0.024).

CONCLUSION

Robotic pancreatectomy is safe and oncologically effective for resectable PDAC. OS was comparable between RP and OP, and RFS was improved in the RP group, especially in patients who receive AC.

摘要

背景

目前关于接受机器人胰腺切除术(RP)的胰腺导管腺癌(PDAC)患者的长期肿瘤学结果的数据有限。

方法

纳入 2011 年 1 月至 2019 年 12 月期间接受 RP 和开放胰腺切除术(OP)治疗可切除 PDAC 的所有患者。RP 组通过倾向评分匹配(PSM)与 OP 组 1:1 匹配。收集并分析肿瘤学结果。

结果

总体而言,本研究纳入了 1606 例患者。PSM 后,每组各选择 335 例均衡的患者进行进一步分析。与 OP 组相比,RP 组的手术时间更短(210 分钟 vs. 240 分钟,P < 0.001)、估计出血量更少(200 毫升 vs. 300 毫升,P = 0.011)、伤口感染率更低(4.5% vs. 10.1%,P = 0.005)和术后住院时间更短(15 天 vs. 17 天,P = 0.001),但其他围手术期结果无差异。两组的 OS 无显著差异(31 个月 vs. 28 个月,P = 0.077);然而,RP 组的 RFS 得到改善(17 个月 vs. 14 个月,P = 0.015)。亚组分析显示,在 RP 组接受辅助化疗(AC)的患者的 RFS 优于 OP 组中类似患者队列(17 个月 vs. 14 个月,P = 0.024)。

结论

机器人胰腺切除术治疗可切除 PDAC 是安全且具有肿瘤学疗效的。RP 和 OP 的 OS 无显著差异,RP 组的 RFS 得到改善,尤其是在接受 AC 的患者中。

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