Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China; Organ Transplantation Department, The Three Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Int J Surg. 2022 Aug;104:106819. doi: 10.1016/j.ijsu.2022.106819. Epub 2022 Aug 7.
With the advances in surgical techniques and perioperative management, the surgical indications for pancreaticoduodenectomy have been extended to elderly patients. Whether robotic pancreaticoduodenectomy (RPD) is superior to open pancreaticoduodenectomy (OPD) in older patients remains uncertain. Thus, this study aimed to compare perioperative outcomes between RPD and OPD in elderly patients.
The demographics and perioperative outcomes of a consecutive series of elderly patients (aged ≥75 years) who underwent RPD or OPD at seven pancreatic centers in China between July 2011 and July 2020 were retrospectively analyzed.
Of the 302 patients included in this study, 169 underwent RPD and 133 underwent OPD. The RPD group had a shorter operative time (OT) (264.3 vs. 278.2 min, P = 0.01) and less estimated blood loss (EBL) (100 (50 150) vs. 200 (150 300) mL, P < 0.001) than the OPD group. RPDs in 3 (1.8%) patients were converted to OPD. The postoperative length of stay (LOS) after RPD was significantly shorter than that after OPD (13.0 vs. 17.0 days, P < 0.001). No significant differences were found in the rates of clinically relevant postoperative pancreatic fistula, bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage, major morbidity, reoperation, 90-day readmission, or 90-day mortality between the two groups (P > 0.05). The multivariate logistic regression analysis revealed that type 2 diabetes, chronic obstructive pulmonary disease, postoperative hemorrhage, and cardiac events were independent risk factors for postoperative 90-day mortality.
This study demonstrated that RPD was comparable to OPD in terms of safety and feasibility in elderly patients with shorter OT, lower EBL, and shorter postoperative LOS. Surgical approach was not an independent risk factor for 90-day mortality.
随着外科技术和围手术期管理的进步，胰十二指肠切除术的手术适应证已扩展至老年患者。机器人辅助胰十二指肠切除术（RPD）是否优于老年患者的开放胰十二指肠切除术（OPD）尚不确定。因此，本研究旨在比较老年患者中 RPD 和 OPD 的围手术期结果。
回顾性分析 2011 年 7 月至 2020 年 7 月期间中国 7 个胰腺中心连续系列接受 RPD 或 OPD 的老年患者（年龄≥75 岁）的人口统计学和围手术期结果。
本研究共纳入 302 例患者，其中 169 例行 RPD，133 例行 OPD。RPD 组的手术时间（OT）更短（264.3 比 278.2 分钟，P=0.01），估计出血量（EBL）更少（100（50150）比 200（150300）毫升，P<0.001）。3（1.8%）例 RPD 转为 OPD。RPD 术后住院时间（LOS）明显短于 OPD（13.0 比 17.0 天，P<0.001）。两组术后胰瘘、胆漏、胃排空延迟、胰周出血、主要并发症、再手术、90 天再入院和 90 天死亡率发生率无显著差异（P>0.05）。多因素逻辑回归分析显示，2 型糖尿病、慢性阻塞性肺疾病、术后出血和心脏事件是术后 90 天死亡的独立危险因素。
本研究表明，RPD 在老年患者中与 OPD 一样安全可行，OT 更短，EBL 更低，术后 LOS 更短。手术方式不是 90 天死亡率的独立危险因素。
