Ngongoni Rejoice F, Mlambo Busisiwe, Shih I-Fan, Li Yanli, Wren Sherry M
Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
Intuitive Surgical, Sunnyvale, California, USA.
World J Surg. 2025 Jan;49(1):241-252. doi: 10.1002/wjs.12408. Epub 2024 Nov 22.
To evaluate recent minimally invasive pancreatectomy (MIP) trends for neoplastic disease and compare perioperative outcomes.
Patients who underwent open (OS) or MIP (laparoscopic-LS or robotic-RS) pancreaticoduodenectomy (PD) or non-pancreati-coduodenectomy resections (non-PD) were identified from PINC AI Healthcare Database. Outcomes were compared using multivariable regressions.
OS was the predominant approach for PD (87.8%); MIP was more common in non-PD (48.5%) than PD with a substantial RS uptake (11.7%-29.9%). In PDs, outcomes were similar except OS had a longer length of stay (LOS) and lower costs. In non-PDs, MIP patients were less likely to have prolonged LOS, intensive care unit admission, and overall complications than OS. Conversion to OS was lower in the RS approach than LS in PD and non-PD.
MIP for non-PD has become the most common operative approach with improved outcomes; MIP-PD has flat adoption and similar outcomes to OS. Robotics facilitates MIP (PD and non-PD) completion through fewer conversions to open surgery (OS).
评估近期微创胰腺切除术（MIP）治疗肿瘤性疾病的趋势，并比较围手术期结果。
从PINC AI医疗数据库中识别出接受开放手术（OS）或MIP（腹腔镜-LS或机器人-RS）胰十二指肠切除术（PD）或非胰十二指肠切除术（非PD）的患者。使用多变量回归比较结果。
OS是PD的主要手术方式（87.8%）；MIP在非PD中比PD更常见（48.5%），且机器人手术的采用率较高（11.7%-29.9%）。在PD手术中，除了OS住院时间更长、费用更低外，其他结果相似。在非PD手术中，MIP患者出现住院时间延长、入住重症监护病房和总体并发症的可能性低于OS患者。在PD和非PD手术中，机器人手术转为OS的比例低于腹腔镜手术。
非PD的MIP已成为最常见的手术方式，且结果有所改善；MIP-PD的采用率持平，结果与OS相似。机器人手术通过减少转为开放手术（OS）的次数，促进了MIP（PD和非PD）的完成。
