Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Cancer Center Amsterdam, The Netherlands.
Int J Surg. 2024 Jun 1;110(6):3554-3561. doi: 10.1097/JS9.0000000000001315.
International guidelines recommend monitoring the use and outcome of minimally invasive pancreatic surgery (MIPS). However, data from prospective international audits on minimally invasive distal pancreatectomy (MIDP) are lacking. This study examined the use and outcome of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the E-MIPS registry.
Post-hoc analysis in a prospective audit on MIPS, including consecutive patients undergoing MIDP in 83 centers from 19 European countries (01-01-2019/31-12-2021). Primary outcomes included intraoperative events (grade 1: excessive blood loss, grade 2: conversion/change in operation, grade 3: intraoperative death), major morbidity, and in-hospital/30-day mortality. Multivariable logistic regression analyses identified high-risk groups for intraoperative events. RDP and LDP were compared in the total cohort and high-risk groups.
Overall, 1672 patients undergoing MIDP were included; 606 (36.2%) RDP and 1066 (63.8%) LDP. The annual use of RDP increased from 30.5% to 42.6% ( P <0.001). RDP was associated with fewer grade 2 intraoperative events compared with LDP (9.6% vs. 16.8%, P <0.001), with longer operating time (238 vs. 201 min, P <0.001). No significant differences were observed between RDP and LDP regarding major morbidity (23.4% vs. 25.9%, P =0.264) and in-hospital/30-day mortality (0.3% vs. 0.8%, P =0.344). Three high-risk groups were identified; BMI greater than 25 kg/m 2 , previous abdominal surgery, and vascular involvement. In each group, RDP was associated with fewer conversions and longer operative times.
This European registry-based study demonstrated favorable outcomes for MIDP, with mortality rates below 1%. LDP remains the predominant approach, whereas the use of RDP is increasing. RDP was associated with fewer conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.
国际指南建议监测微创胰腺手术（MIPS）的使用情况和结果。然而，缺乏关于微创胰体尾切除术（MIDP）的前瞻性国际审核数据。本研究在 E-MIPS 注册研究中检查了机器人辅助（RDP）和腹腔镜（LDP）胰体尾切除术的使用情况和结果。
对 MIPS 的前瞻性审核进行了回顾性分析，包括 19 个欧洲国家 83 个中心的连续接受 MIDP 的患者（2019 年 1 月 1 日至 2021 年 12 月 31 日）。主要结局包括术中事件（1 级：大量失血，2 级：中转/手术方式改变，3 级：术中死亡）、主要并发症和院内/30 天死亡率。多变量逻辑回归分析确定了术中事件的高危人群。在总队列和高危组中比较了 RDP 和 LDP。
共纳入 1672 例行 MIDP 的患者；606 例行 RDP（36.2%），1066 例行 LDP（63.8%）。RDP 的年使用率从 30.5%增加到 42.6%（P<0.001）。与 LDP 相比，RDP 与较少的 2 级术中事件相关（9.6% vs. 16.8%，P<0.001），手术时间更长（238 分钟 vs. 201 分钟，P<0.001）。RDP 和 LDP 在主要并发症（23.4% vs. 25.9%，P=0.264）和院内/30 天死亡率（0.3% vs. 0.8%，P=0.344）方面无显著差异。确定了 3 个高危人群；BMI 大于 25kg/m 2 、既往腹部手术和血管受累。在每个组中，RDP 与较低的转化率和较长的手术时间相关。
这项基于欧洲注册的研究表明 MIDP 的结果良好，死亡率低于 1%。LDP 仍然是主要方法，而 RDP 的使用率正在增加。RDP 与较低的转化率和较长的手术时间相关，包括在高危亚组中。未来的随机试验应证实这些发现并评估成本差异。
