Zheng Richard, Ghabi Elie, He Jin
Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD 21287, USA.
Cancers (Basel). 2023 Sep 1;15(17):4369. doi: 10.3390/cancers15174369.
Parenchymal-sparing approaches to pancreatectomy are technically challenging procedures but allow for preserving a normal pancreas and decreasing the rate of postoperative pancreatic insufficiency. The robotic platform is increasingly being used for these procedures. We sought to evaluate robotic parenchymal-sparing pancreatectomy and assess its complication profile and efficacy.
This systematic review consisted of all studies on robotic parenchymal-sparing pancreatectomy (central pancreatectomy, duodenum-preserving partial pancreatic head resection, enucleation, and uncinate resection) published between January 2001 and December 2022 in PubMed and Embase.
A total of 23 studies were included in this review ( = 788). Robotic parenchymal-sparing pancreatectomy is being performed worldwide for benign or indolent pancreatic lesions. When compared to the open approach, robotic parenchymal-sparing pancreatectomies led to a longer average operative time, shorter length of stay, and higher estimated intraoperative blood loss. Postoperative pancreatic fistula is common, but severe complications requiring intervention are exceedingly rare. Long-term complications such as endocrine and exocrine insufficiency are nearly nonexistent.
Robotic parenchymal-sparing pancreatectomy appears to have a higher risk of postoperative pancreatic fistula but is rarely associated with severe or long-term complications. Careful patient selection is required to maximize benefits and minimize morbidity.
保留实质的胰腺切除术在技术上具有挑战性，但能够保留正常胰腺并降低术后胰腺功能不全的发生率。机器人手术平台越来越多地用于这些手术。我们旨在评估机器人保留实质的胰腺切除术，并评估其并发症情况和疗效。
本系统评价纳入了2001年1月至2022年12月期间发表在PubMed和Embase上的所有关于机器人保留实质的胰腺切除术（中央胰腺切除术、保留十二指肠的部分胰头切除术、剜除术和钩突切除术）的研究。
本评价共纳入23项研究（n = 788）。机器人保留实质的胰腺切除术在全球范围内用于治疗良性或惰性胰腺病变。与开放手术相比，机器人保留实质的胰腺切除术的平均手术时间更长，住院时间更短，估计术中失血量更多。术后胰瘘很常见，但需要干预的严重并发症极为罕见。内分泌和外分泌功能不全等长期并发症几乎不存在。
机器人保留实质的胰腺切除术术后胰瘘风险似乎较高，但很少与严重或长期并发症相关。需要仔细选择患者，以最大化获益并最小化发病率。
