Kang Jae Seung, Lee Mirang, Lee Jun Suh, Han Youngmin, Sohn Hee Ju, Lee Boram, Kim Moonhwan, Kwon Wooil, Han Ho-Seong, Yoon Yoo-Seok, Jang Jin-Young
Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery and Robot Surgery Center, Myongju Hospital, Yongin, Korea.
Ann Hepatobiliary Pancreat Surg. 2024 Nov 30;28(4):508-515. doi: 10.14701/ahbps.24-121. Epub 2024 Sep 24.
BACKGROUNDS/AIMS: Minimally invasive pancreatoduodenectomy (MIPD), such as totally laparoscopic pancreatoduodenectomy (TLPD) or robot-assisted pancreatoduodenectomy (RAPD), is increasingly performed worldwide. This study aimed to compare the perioperative outcomes of TLPD and RAPD, and compare the oncologic outcomes between MIPD and open pancreatoduodenectomy (OPD) for malignant disease.
This retrospective study was conducted at two hospitals that followed similar oncological surgical principles, including the extent of resection. RAPD was performed at Seoul National University Hospital, and TLPD at Seoul National University Bundang Hospital. Patient demographics, perioperative outcomes, and oncological outcomes were analyzed. Propensity score matching (PSM) analysis was performed to compare oncologic outcomes between MIPD and OPD.
Between 2015 and 2020, 332 RAPD and 178 TLPD were performed. The rates of Clavian-Dindo grade ≥ 3 complications (19.3% vs. 20.2%, = 0.816), clinically relevant postoperative pancreatic fistula (9.9% vs. 11.8%, = 0.647), and open conversions (6.6% vs. 10.5%, = 0.163) were comparable between the two groups. The mean operation time (341 minutes vs. 414 minutes, < 0.001) and postoperative hospital stay were shorter in the RAPD group (11 days vs. 14 days, = 0.034). After PSM, the 5-year overall survival rate was comparable between MIPD and OPD for overall malignant disease (58.4% vs. 55.5%, = 0.180).
Both RAPD and TLPD are safe and feasible, and MIPD has clinical outcomes that are comparable to those of OPD. Although RAPD exhibits some advantages, its perioperative outcomes are similar to those associated with TLPD. A surgical method may be selected based on the convenience of surgical movements, medical costs, and operator experience.
背景/目的：微创胰十二指肠切除术（MIPD），如全腹腔镜胰十二指肠切除术（TLPD）或机器人辅助胰十二指肠切除术（RAPD），在全球范围内的开展越来越多。本研究旨在比较TLPD和RAPD的围手术期结局，并比较MIPD与开放胰十二指肠切除术（OPD）治疗恶性疾病的肿瘤学结局。
本回顾性研究在两家遵循相似肿瘤外科原则（包括切除范围）的医院进行。RAPD在首尔国立大学医院进行，TLPD在首尔国立大学盆唐医院进行。分析了患者的人口统计学资料、围手术期结局和肿瘤学结局。采用倾向评分匹配（PSM）分析比较MIPD和OPD的肿瘤学结局。
2015年至2020年期间，共进行了332例RAPD和178例TLPD。两组患者的Clavian-Dindo≥3级并发症发生率（19.3%对20.2%，P = 0.816）、临床相关的术后胰瘘发生率（9.9%对11.8%，P = 0.647）和中转开放手术率（6.6%对10.5%，P = 0.163）相当。RAPD组的平均手术时间（341分钟对414分钟，P < 0.001）和术后住院时间更短（11天对14天，P = 0.034）。PSM分析后，MIPD和OPD治疗总体恶性疾病的5年总生存率相当（58.4%对55.5%，P = 0.180）。
RAPD和TLPD均安全可行，MIPD的临床结局与OPD相当。虽然RAPD有一些优势，但其围手术期结局与TLPD相似。可根据手术操作的便利性、医疗成本和术者经验选择手术方式。
