Department of General Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1, Shuai Fu Yuan, Dongcheng, Beijing, 100730, China.
Surg Endosc. 2023 May;37(5):3823-3831. doi: 10.1007/s00464-023-09865-3. Epub 2023 Jan 23.
Few studies have evaluated the preoperative factors predicting the surgical difficulty of robotic distal pancreatectomy (RDP). This study aims to explore such factors and provide guidance on the selection of suitable patients to aid surgeons lacking extensive experience in RDP.
A retrospective study was conducted on consecutive patients who underwent RDP to identify preoperative factors predicting surgical difficulty. High surgical difficulty was defined by both operation time and intraoperative estimated blood loss exceeding their median, or by conversion to laparotomy.
A total of 161 patients were ultimately enrolled, including 51 patients with high levels of surgical difficulty. Multivariate analysis revealed that male sex [OR (95% CI): 4.07 (1.77,9.40), p = 0.001], body mass index (BMI) ≥ 25 kg/m OR (95% CI): 2.27 (1.03,5.00), p = 0.042], tumors located at the neck of the pancreas [OR (95% CI): 4.15 (1.49,11.56), p = 0.006] and splenic artery type B [OR (95% CI): 3.28 (1.09,9.91), p = 0.035] were independent risk factors for surgical difficulty. Regarding postoperative complications, high surgical difficulty was associated with the risk of overall complications and pancreatic fistula (grade B/C) (49.0% vs. 22.7%, p < 0.001; 39.2% vs. 19.1%, p = 0.006).
Male sex, body mass index ≥ 25 kg/m2, tumor located at the neck of the pancreas and splenic artery type B are associated with a high RDP difficulty level. These factors can be used preoperatively to assess the difficulty level of surgery, to help surgeons choose patients suitable for them and ensure surgical safety.
很少有研究评估预测机器人胰体尾切除术（RDP）手术难度的术前因素。本研究旨在探讨这些因素，并为选择合适的患者提供指导，以帮助缺乏 RDP 丰富经验的外科医生。
对连续接受 RDP 的患者进行回顾性研究，以确定预测手术难度的术前因素。高手术难度定义为手术时间和术中估计出血量超过中位数，或转为开腹手术。
共纳入 161 例患者，其中 51 例手术难度较高。多因素分析显示，男性（OR（95%CI）：4.07（1.77，9.40），p=0.001）、BMI≥25 kg/m2（OR（95%CI）：2.27（1.03，5.00），p=0.042）、肿瘤位于胰颈（OR（95%CI）：4.15（1.49，11.56），p=0.006）和脾动脉 B 型（OR（95%CI）：3.28（1.09，9.91），p=0.035）是手术难度的独立危险因素。关于术后并发症，高手术难度与总体并发症和胰瘘（B/C 级）的风险相关（49.0%比 22.7%，p<0.001；39.2%比 19.1%，p=0.006）。
男性、BMI≥25 kg/m2、肿瘤位于胰颈和脾动脉 B 型与 RDP 难度水平高相关。这些因素可用于术前评估手术难度，帮助外科医生选择适合他们的患者，并确保手术安全。
