Kalabin Aleksandr, Mani Vishnu R, Kruse Robin L, Schlesselman Chase, Li Kai Yu, Staveley-O'Carroll Kevin F, Kimchi Eric T
Department of Surgery, University of Missouri, Columbia, MO 65212, United States.
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States.
World J Gastrointest Surg. 2023 Jan 27;15(1):60-71. doi: 10.4240/wjgs.v15.i1.60.
Pancreatic ductal adenocarcinoma is a common malignancy. Despite all advancements, the prognosis remains, poor with an overall 5-year survival of only 10.8%. Recently, a robotic platform has become an attractive tool for treating pancreatic cancer (PC). While recent studies indicated improved lymph node (LN) harvest during robotic pancreaticoduodenectomy (PD), data on long-term outcomes are insufficient.
To evaluate absolute LN harvest during PD. Secondary outcomes included evaluating the association between LN harvest and short- and long-term oncological outcomes for three different surgical approaches.
We conducted an analysis of the National Cancer Database, including patients diagnosed with PC who underwent open, laparoscopic, or robotic PD in 2010-2018. One-way analysis of variance was used to compare continuous variables, chi-square test - for categorical. Overall survival was defined as the time between surgery and death. Median survival time was estimated with the Kaplan-Meier method, and groups were compared with the Wilcoxon test. A Cox proportional hazards model was used to assess the association of covariates with survival after controlling for patient characteristics and procedure type.
17169 patients were included, 8859 (52%) males; mean age 65; 14509 (85%) white. 13816 (80.5%) patients had an open PD, 2677 (15.6%) and 676 (3.9%) - laparoscopic and robotic PD respectively. Mean comorbidity index (Charlson-Deyo Score) 0.50. On average, 18.84 LNs were harvested. Mean LN harvest during open, laparoscopic and robotic PD was 18.59, 19.65 and 20.70 respectively ( < 0.001). On average 2.49 LNs were positive for cancer and did not differ by the procedure type ( = 0.26). Vascular invasion was noted in 42.6% of LNs and did differ by the approach: 42.1% for open, 44.0% for laparoscopic and 47.2% for robotic PD ( = 0.015). Median survival for open PD was 26.1 mo, laparoscopic - 27.2 mo, robotic - 29.1 mo ( = 0.064). Survival was associated with higher LN harvest, while higher number of positive LNs was associated with higher mortality.
Our study suggests that robotic PD is associated with increased intraoperative LN harvest and has comparable short-term oncological outcomes and survival compared to open and laparoscopic approaches.
胰腺导管腺癌是一种常见的恶性肿瘤。尽管取得了所有进展，但其预后仍然很差，总体5年生存率仅为10.8%。最近，机器人平台已成为治疗胰腺癌（PC）的一种有吸引力的工具。虽然最近的研究表明机器人胰十二指肠切除术（PD）期间淋巴结（LN）清扫有所改善，但长期结果的数据不足。
评估胰十二指肠切除术中的绝对淋巴结清扫情况。次要结果包括评估三种不同手术方法的淋巴结清扫与短期和长期肿瘤学结果之间的关联。
我们对国家癌症数据库进行了分析，纳入了2010 - 2018年诊断为胰腺癌并接受开放、腹腔镜或机器人胰十二指肠切除术的患者。采用单因素方差分析比较连续变量，卡方检验用于分类变量。总生存时间定义为手术至死亡的时间。用Kaplan - Meier方法估计中位生存时间，并用Wilcoxon检验比较各组。使用Cox比例风险模型评估在控制患者特征和手术类型后协变量与生存的关联。
共纳入17169例患者，8859例（52%）为男性；平均年龄65岁；14509例（85%）为白人。13816例（80.5%）患者接受了开放胰十二指肠切除术，2677例（15.6%）和676例（3.9%）分别接受了腹腔镜和机器人胰十二指肠切除术。平均合并症指数（Charlson - Deyo评分）为0.50。平均清扫淋巴结18.84枚。开放、腹腔镜和机器人胰十二指肠切除术期间的平均淋巴结清扫数分别为18.59枚、19.65枚和20.70枚（<0.001）。平均有2.49枚淋巴结癌转移阳性，不同手术方式之间无差异（=0.26）。42.6%的淋巴结有血管侵犯，不同手术方式存在差异：开放手术为42.1%，腹腔镜手术为
