一种更优越的方法？利用 2019-2022 年 MBSAQIP 数据库评估机器人袖状胃切除术在超级肥胖患者中的作用。

A superior approach? The role of robotic sleeve gastrectomy in patients with super super obesity using the 2019-2022 MBSAQIP database.

机构信息

Department of Surgery, Northwest Hospital, Randallstown, MD, USA.

Universidad Cientifica del Sur, Lima, Peru.

出版信息

Surg Endosc. 2024 Aug;38(8):4594-4603. doi: 10.1007/s00464-024-10955-z. Epub 2024 Jun 11.

DOI:10.1007/s00464-024-10955-z

PMID:38862824

Abstract

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) in patients with BMI ≥ 60 presents technical challenges, that might be overcome by robotic surgery, but its effectiveness has not been rigorously evaluated. We compared the 30-day outcomes of LSG and robotic sleeve gastrectomy (RSG) in patients with BMI < 60 versus ≥ 60 and between LSG and RSG in patients with BMI ≥ 60.

METHODS

Patients aged 18-65 years who underwent sleeve gastrectomy were included using the 2019-2022 MBSAQIP database. We performed a Propensity Score Matching analysis, with 21 preoperative characteristics. We compared 30-day postoperative outcomes for patients with BMI < 60 versus ≥ 60 using either a laparoscopic (Analysis 1) or robotic approach (Analysis 2) and compared LSG versus RSG in patients with BMI ≥ 60 (Analysis 3).

RESULTS

297,250 patients underwent LSG and 81,008 RSG. Propensity-matched¸ outcomes in analysis 1 (13,503 matched cases), showed that patients with BMI ≥ 60 had higher rates of mortality (0.1% vs. 0.0%, p = 0.014), staple line leak (0.3% vs. 0.2%, p = 0.035), postoperative bleeding (0.2% vs 0.1%, p = 0.028), readmissions (3.5% vs. 2.4%, p < 0.001), and interventions (0.7% vs. 0.5%, p = 0.028) when compared to patients with BMI < 60. In analysis 2 (4350 matched cases), patients with BMI ≥ 60 demonstrated longer operative times, length of stay, and higher rates of unplanned ICU when compared to patients with BMI < 60. In analysis 3 (4370 matched cases), patients who underwent RSG had fewer readmissions (2.9% vs. 3.7%, p = 0.037), staple line leaks (0.1% vs. 0.3%, p = 0.029), and postoperative bleeding (0.1% vs. 0.3%, p = 0.045), compared to LSG. Conversely, a longer operative time (92.74 ± 38.65 vs. 71.69 ± 37.45 min, p < 0.001) was reported.

CONCLUSION

LSG patients with BMI ≥ 60 have higher rates of complications compared to patients with a BMI < 60. Moreover, some outcomes may be improved with the robotic approach in patients with BMI ≥ 60. These results underscore the importance of considering a robotic approach in this super super obese population.

摘要

背景

对于 BMI≥60 的患者，腹腔镜袖状胃切除术（LSG）具有一定的技术难度，而机器人手术可能会克服这些困难，但尚未对其疗效进行严格评估。我们比较了 BMI＜60 与≥60 的患者中 LSG 和机器人袖状胃切除术（RSG）的 30 天术后结局，以及 BMI≥60 的患者中 LSG 和 RSG 的 30 天术后结局。

方法

我们使用 2019-2022 年 MBSAQIP 数据库纳入了年龄在 18-65 岁之间接受袖状胃切除术的患者。我们进行了倾向评分匹配分析，纳入了 21 项术前特征。我们分别采用腹腔镜（分析 1）或机器人（分析 2）方法比较了 BMI＜60 与≥60 的患者的 30 天术后结局，并比较了 BMI≥60 的患者的 LSG 与 RSG（分析 3）。

结果

共有 297250 例患者接受了 LSG 治疗，81008 例患者接受了 RSG 治疗。在倾向评分匹配的分析 1（13503 例匹配病例）中，BMI≥60 的患者的死亡率（0.1%比 0.0%，p=0.014）、吻合口漏（0.3%比 0.2%，p=0.035）、术后出血（0.2%比 0.1%，p=0.028）、再入院率（3.5%比 2.4%，p＜0.001）和干预率（0.7%比 0.5%，p=0.028）均较高。在分析 2（4350 例匹配病例）中，BMI≥60 的患者的手术时间、住院时间和非计划性 ICU 入住率均较长。在分析 3（4370 例匹配病例）中，与 LSG 相比，RSG 患者的再入院率（2.9%比 3.7%，p=0.037）、吻合口漏（0.1%比 0.3%，p=0.029）和术后出血（0.1%比 0.3%，p=0.045）均较低。然而，RSG 的手术时间较长（92.74±38.65 比 71.69±37.45 分钟，p＜0.001）。