Department of Visceral Surgery, University Hospital of Geneva (HUG), Rue Gabrielle-Perret Gentil 4, Geneve, Switzerland.
Department of Visceral Surgery, Hospital of Lugano (EOC), Via Tesserete 46, 6900 Lugano, Switzerland.
HPB (Oxford). 2023 Jun;25(6):603-613. doi: 10.1016/j.hpb.2023.02.014. Epub 2023 Feb 24.
Minimally Invasive Pancreatic Enucleation, either laparoscopic or robot-assisted, is rarely performed. The aim of this study was to offer the current available evidence about the outcomes of minimally invasive pancreatic enucleations and explore the possible advantage of this approach over traditional surgery.
PubMed (MEDLINE), Cochrane Library and Embase (ELSEVIER) medical databases were searched for articles published from January 1990 to March 2022. Studies which included more than 10 cases of minimally-invasive pancreatic enucleation were included. Data on the outcomes were synthetized and meta-analyzed when appropriate.
Twenty studies published between 2009 and 2022 with a total of 552 patients were included in the systematic review: three hundred fifty-one patients (63.5%) had a laparoscopic intervention, two hundred and one (36.5%) robot-assisted with a cumulative incidence of conversion rate of 5%. Minimally-invasive surgery was performed in 63% of cases on the body/tail of the Pancreas and in 37% of the cases on the head/uncinate process of the Pancreas. The cumulative post-operative 30 days - mortality rate was 0.2% and the major postoperative morbidity (Clavien-Dindo III-IV-V) 35%. Clinically relevant pancreatic fistula was observed in 17% of the patients. Compared with the standardized open approach (n: 366 patients), mean length of hospital stay was significantly reduced in patients undergoing minimally invasive pancreatic enucleation (2.45 days, p = 0.003) with a favorable trend for post-operative major morbidity (Clavien-Dindo III-IV) (- 24% RR, p: 0.13). Operative time, blood loss and clinically relevant pancreatic fistula rate were comparable between the two groups. One hundred and fourteen robot-assisted enucleations entered in a subgroup analysis with comparable results to open surgery.
Minimally-Invasive approach for pancreatic enucleation is safe, feasible and offers short-term clinical outcomes comparable with open surgery. The potential benefit of robotic surgery will need to be verified in further studies.
微创胰腺部分切除术，无论是腹腔镜还是机器人辅助，都很少进行。本研究的目的是提供微创胰腺部分切除术结果的现有证据，并探讨这种方法相对于传统手术的可能优势。
检索 1990 年 1 月至 2022 年 3 月期间发表的医学数据库 PubMed（MEDLINE）、Cochrane 图书馆和 Embase（ELSEVIER）中的文章。纳入超过 10 例微创胰腺部分切除术的研究。对适当的数据进行综合和荟萃分析。
共纳入 2022 年发表的 20 项研究，共 552 例患者：351 例（63.5%）接受腹腔镜干预，201 例（36.5%）机器人辅助，累计中转率为 5%。微创手术在胰腺体尾部进行 63%，在胰头/钩突进行 37%。术后 30 天死亡率为 0.2%，主要术后并发症（Clavien-Dindo III-IV-V）为 35%。观察到 17%的患者存在临床相关的胰瘘。与标准化的开放手术（n=366 例）相比，接受微创胰腺部分切除术的患者住院时间明显缩短（2.45 天，p=0.003），术后主要并发症（Clavien-Dindo III-IV）的发生率也有降低的趋势（24%RR，p：0.13）。两组手术时间、出血量和临床相关胰瘘发生率无差异。对 114 例机器人辅助胰腺部分切除术进行了亚组分析，结果与开放手术相当。
微创胰腺部分切除术安全可行，短期临床结果与开放手术相当。机器人手术的潜在优势需要进一步研究证实。
