Hao Qisheng, Cha Lichao, Zhou Bin, Li Xinyu, Gong Mingkai, Li Qingze, Dong Guofei, Song Mengqi, Wu Zehua, Guo Zhongyi, Qiu Fabo, Wang Xiaowei, Tian Lantian
Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Retroperitoneal Tumor Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Front Oncol. 2024 Jul 23;14:1414780. doi: 10.3389/fonc.2024.1414780. eCollection 2024.
The Da Vinci Surgical System (DVSS) has the advantages of minimal invasion, rapid recovery, safety, and reliability. Although the DVSS has been widely used in various abdominal surgeries, descriptions of its use in robot-assisted retroperitoneal tumor resection (RRTR) are limited to case reports; large-sample systematic studies are lacking. The present study was performed to analyze the data of RRTR in our center, summarize our experience, and provide a reference for other retroperitoneal tumor centers.
We retrospectively analyzed the clinical data of 105 patients who underwent RRTR at the Affiliated Hospital of Qingdao University from January 2015 to December 2022. Logistic univariate and multivariate analyses were performed to identify independent risk factors affecting RRTR. A receiver operating characteristic curve was used to find the cut-off value, which was then included in the logistic multivariate analysis for verification.
Among the 105 patients, 87 successfully underwent RRTR (DVSS group) and 18 underwent conversion to open surgery (conversion group). There was no significant difference in sex, age, body mass index, history of abdominal surgery, or tumor location between the two groups (P > 0.05). The maximum tumor diameter [odds ratio (OR), 1.041; 95% confidence interval (CI), 1.015-1.067; P = 0.002] and pathological property (OR, 8.646; 95% CI, 2.370-31.544; P = 0.001) were independent risk factors for conversion to open surgery. Further analysis confirmed that the success rate of RRTR was higher for tumors with a maximum diameter of ≤64 mm and benign tumors. Based on our experience and statistical results, we believe that retroperitoneal tumors that meet the following criteria have a higher success rate of DVSS resection: maximum tumor diameter of ≤64 mm, benign tumors, the tumor has relatively clear boundary, no obvious invasion of surrounding tissues and organs, and no need for combined organ resection.
RRTR is safe and effective in the treatment of RPT, and the clinical prognosis is similar to that of open surgery. The success rate of RRTR in patients with appropriate surgical indications for this procedure is higher.
达芬奇手术系统（DVSS）具有微创、恢复快、安全可靠等优点。尽管DVSS已广泛应用于各种腹部手术，但其在机器人辅助腹膜后肿瘤切除术（RRTR）中的应用描述仅限于病例报告，缺乏大样本的系统研究。本研究旨在分析我院RRTR的数据，总结经验，为其他腹膜后肿瘤中心提供参考。
回顾性分析2015年1月至2022年12月在青岛大学附属医院接受RRTR的105例患者的临床资料。进行单因素和多因素Logistic分析以确定影响RRTR的独立危险因素。采用受试者工作特征曲线确定临界值，然后将其纳入多因素Logistic分析进行验证。
105例患者中，87例成功接受RRTR（DVSS组）；18例中转开腹手术（中转组）。两组患者在性别、年龄、体重指数、腹部手术史或肿瘤位置方面无显著差异（P>0.05）。最大肿瘤直径[比值比（OR），1.041；95%置信区间（CI），1.015 - 1.067；P = 0.002]和病理性质（OR，8.646；95%CI，2.370 - 31.544；P = 0.001）是中转开腹手术的独立危险因素。进一步分析证实，最大直径≤64mm的肿瘤和良性肿瘤的RRTR成功率更高。根据我们的经验和统计结果，我们认为符合以下标准的腹膜后肿瘤DVSS切除成功率更高：最大肿瘤直径≤64mm、良性肿瘤、肿瘤边界相对清晰、无明显周围组织器官侵犯且无需联合器官切除。
RRTR治疗腹膜后肿瘤安全有效，临床预后与开腹手术相似。具有合适手术指征的患者RRTR成功率更高。
