Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Surg Endosc. 2023 May;37(5):4028-4039. doi: 10.1007/s00464-022-09602-2. Epub 2022 Sep 12.
Evidence of the advantages of robotic pancreaticoduodenectomy (RPD) over laparoscopic pancreaticoduodenectomy (LPD) is limited. Thus, this study aimed to compare the surgical outcomes of laparoscopic reconstruction L-recon) versus robotic reconstruction (R-recon) in patients with soft pancreas and small pancreatic duct.
Among 429 patients treated with minimally invasive pancreaticoduodenectomy (MIPD) between October 2012 and June 2020 by three surgeons at three institutions, 201 patients with a soft pancreas and a small pancreatic duct (< 3 mm) were included in this study.
Sixty pairs of patients who underwent L-recon and R-recon were selected after propensity score matching. The perioperative outcomes were comparable between the reconstruction approaches, with comparable clinically relevant postoperative pancreatic fistula (CR-POPF) rates (15.0% [L-recon] vs. 13.3% [R-recon]). The sub-analysis according to the type of MIPD procedure also showed comparable outcomes, but only a significant difference in postoperative hospital stay was identified. During the learning curve analysis using the cumulative summation by operation time (CUSUM), two surgeons who performed both L-recon and R-recon procedures reached their first peak in the CUSUM graph earlier for the R-recon group than for the L-recon group (i.e., 20th L-recon case and third R-recon case of surgeon A and 43rd L-recon case and seventh R-recon case of surgeon B). Surgeon C, who only performed R-recon, demonstrated the first peak in the 22nd case. The multivariate regression analysis for risk factors of CR-POPF showed that the MIPD procedure type, as well as other factors, did not have any significant effect.
Postoperative pancreatic fistula rates and the overall perioperative outcomes of L-recon and R-recon were comparable in patients with soft-textured pancreas and small pancreatic duct treated by experienced surgeons.
机器人胰十二指肠切除术（RPD）优于腹腔镜胰十二指肠切除术（LPD）的证据有限。因此，本研究旨在比较胰腺软和胰管小（<3mm）患者中腹腔镜重建（L-recon）与机器人重建（R-recon）的手术结果。
在 2012 年 10 月至 2020 年 6 月期间，由三位外科医生在三家机构对 429 例接受微创胰十二指肠切除术（MIPD）的患者进行治疗，其中 201 例胰腺质地柔软且胰管较小（<3mm）的患者纳入本研究。
在倾向评分匹配后，选择了 60 对接受 L-recon 和 R-recon 的患者。两种重建方法的围手术期结果相似，具有相似的临床相关胰瘘（CR-POPF）发生率（15.0% [L-recon] vs. 13.3% [R-recon]）。根据 MIPD 手术类型的亚分析也显示了相似的结果，但只有术后住院时间存在显著差异。使用手术时间累积和（CUSUM）进行学习曲线分析时，两位同时进行 L-recon 和 R-recon 手术的外科医生在 R-recon 组的 CUSUM 图中比 L-recon 组更早达到第一个峰值（即外科医生 A 的第 20 例 L-recon 病例和第 3 例 R-recon 病例，以及外科医生 B 的第 43 例 L-recon 病例和第 7 例 R-recon 病例）。仅进行 R-recon 的外科医生 C 在第 22 例病例中达到了第一个峰值。多变量回归分析显示，CR-POPF 的危险因素包括 MIPD 手术类型以及其他因素均无显著影响。
对于胰腺质地柔软且胰管较小的经验丰富的外科医生治疗的患者，L-recon 和 R-recon 的术后胰瘘发生率和整体围手术期结果相当。
