机器人手术减轻了胰头十二指肠切除术治疗壶腹周围癌后主要并发症对生存的影响。
Robotic approach mitigates the effect of major complications on survival after pancreaticoduodenectomy for periampullary cancer.
机构信息
Division of Surgical Oncology, University of Pittsburgh Medical Center, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, 15261, USA.
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
出版信息
Surg Endosc. 2023 Feb;37(2):1181-1187. doi: 10.1007/s00464-022-09638-4. Epub 2022 Sep 26.
BACKGROUND
Major complications (MCs) after pancreaticoduodenectomy (PD) are a known independent predictor of worse oncologic outcomes. There are limited data on the effect of major complications on long-term outcomes after robotic PD (RPD). The aim of this study is to compare the effect of MC on overall (OS) and disease-free survival (DFS) after RPD and open PD (OPD).
METHODS
This is a single-center, retrospective review of a prospectively maintained database of all patients undergoing PD for periampullary cancer including ampullary adenocarcinoma, distal cholangiocarcinoma, and duodenal carcinoma. Univariate analysis was performed on all clinical, pathologic, and treatment factors. MCs were defined as Clavien-Dindo ≥ grade 3. Kaplan-Maier survival analysis was performed with log-rank test for group comparison. Multivariable Cox regression analysis was used to identify factors associated with overall survival (OS) in both the OPD and RPD groups.
RESULTS
A total of 190 patients with ampullary carcinoma (n = 98), cholangiocarcinoma (n = 55), and duodenal adenocarcinoma (n = 37) were examined over the study period with 61.1% (n = 116) undergoing RPD and 38.9% (n = 74) undergoing OPD. There was no significant difference in patient demographics between the RPD and OPD cohorts. Furthermore, R0 resection rates, tumor size, and lymph node involvement were similar between the RPD and OPD cohorts. OPD had higher rate of MC (40.5% vs 28.3% in RPD, p = 0.011) including clinically relevant pancreatic fistula (25.7% vs 8.6%, p = 0.001) and wound infection (34.5% vs 13.8%, p < 0.001). MCs were associated with a lower OS in the OPD cohort (HR = 2.18, 95%CI 1.0-4.55, p = 0.038). MCs were not associated with OS in the RPD cohort (HR = 1.55, 95%CI 0.87-2.76, p = 0.14).
CONCLUSION
MCs are associated with worse patient outcomes after OPD but not after RPD. Robotic approach mitigates and possibly abrogates the negative effects of MCs on patient outcomes after PD for malignancy and is associated with improved adjuvant chemotherapy completion rates.
背景
胰十二指肠切除术（PD）后的主要并发症（MCs）是已知的独立预测因素，可导致较差的肿瘤学结局。关于机器人 PD（RPD）后 MC 对长期结局的影响，数据有限。本研究旨在比较 MC 对 RPD 和开放 PD（OPD）后总体（OS）和无病生存（DFS）的影响。
方法
这是一项对前瞻性维护的所有接受胰周癌 PD 的患者（包括壶腹腺癌、远端胆管癌和十二指肠腺癌）数据库进行的单中心回顾性研究。对所有临床、病理和治疗因素进行单因素分析。MC 定义为 Clavien-Dindo≥3 级。使用对数秩检验进行 Kaplan-Meier 生存分析以比较组间差异。多变量 Cox 回归分析用于确定 OPD 和 RPD 组中与总生存（OS）相关的因素。
结果
研究期间共检查了 190 例壶腹癌（n=98）、胆管癌（n=55）和十二指肠腺癌（n=37）患者，其中 61.1%（n=116）接受 RPD，38.9%（n=74）接受 OPD。RPD 和 OPD 队列之间的患者人口统计学无显著差异。此外，R0 切除率、肿瘤大小和淋巴结受累在 RPD 和 OPD 队列之间相似。OPD 的 MC 发生率较高（40.5% vs. RPD 中的 28.3%，p=0.011），包括临床相关的胰瘘（25.7% vs. RPD 中的 8.6%，p=0.001）和伤口感染（34.5% vs. OPD 中的 13.8%，p<0.001）。MC 与 OPD 队列的 OS 降低相关（HR=2.18，95%CI 1.0-4.55，p=0.038）。MC 与 RPD 队列的 OS 无关（HR=1.55，95%CI 0.87-2.76，p=0.14）。
结论
MC 与 OPD 后患者结局较差相关，但与 RPD 后患者结局无关。机器人方法减轻了 MC 对恶性肿瘤 PD 后患者结局的负面影响，并且可能消除了这种负面影响，并与辅助化疗完成率的提高相关。
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