机器人胰十二指肠切除术的安全性和可行性：日本425例患者的多中心回顾性评估
The safety and feasibility of robotic pancreaticoduodenectomy: A multicenter retrospective assessment of 425 patients in Japan.
作者信息
Nakamura So, Nakata Kohei, Nagakawa Yuichi, Kozono Shingo, Wakabayashi Go, Wakabayashi Taiga, Uyama Ichiro, Takahara Takeshi, Takeda Yutaka, Ohmura Yoshiaki, Ko Saiho, Nishioka Ayumi, Kiritani Sho, Inoue Yosuke, Adachi Tomohiko, Eguchi Susumu, Morimoto Mamoru, Matsuo Yoichi, Kurahara Hiroshi, Ohtsuka Takao, Nakamura Masafumi
机构信息
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
出版信息
J Hepatobiliary Pancreat Sci. 2025 Feb;32(2):124-131. doi: 10.1002/jhbp.12101. Epub 2024 Dec 23.
BACKGROUND/PURPOSE: The Japanese public health insurance system has recently covered robotic pancreaticoduodenectomy (RPD). This study aimed to review the results of RPD during the introductory period and elucidate its safety and feasibility in Japan.
METHODS
Consecutive data of 425 patients who underwent RPD were retrospectively collected from 10 high-volume centers in Japan between April 2020 and September 2022. The primary endpoints were the rates of conversion to open surgery and completion of minimally invasive surgery (MIS), defined as the use of a totally robotic operation or combined robotic and laparoscopic procedures. Secondary endpoints were operative time, blood loss, complication rate, and 30- and 90-day mortality rates.
RESULTS
Study comprised 222 males and 203 females, with a median age of 70 (p10-p90; 50-81) years. The conversion to open surgery and completion rates of MIS were 3.8% (16 patients) and 91.1% (387 patients), respectively. The median operative time was 617 min (p10-p90; 456-834 min), and the median volume of blood loss was 160 g (p10-p90; 30-558 g). The complication rate (Clavien-Dindo classification grade ≥ IIIa) was 20.5%. The 30- and 90-day mortality rates were 0.2% and 0.5%, respectively.
CONCLUSIONS
Our results indicate that RPD can be introduced successfully and is a promising approach for pancreaticoduodenectomy.
背景/目的：日本公共医疗保险系统最近已将机器人胰十二指肠切除术（RPD）纳入医保范围。本研究旨在回顾RPD在引入期的结果，并阐明其在日本的安全性和可行性。
方法
回顾性收集了2020年4月至2022年9月期间日本10家大型中心连续425例行RPD患者的数据。主要终点是转为开放手术的比例和微创外科手术（MIS）的完成率，MIS定义为完全机器人手术或机器人与腹腔镜联合手术。次要终点是手术时间、失血量、并发症发生率以及30天和90天死亡率。
结果
研究包括222例男性和203例女性，中位年龄为70岁（第10百分位数-第90百分位数；50-81岁）。转为开放手术的比例和MIS的完成率分别为3.8%（16例患者）和91.1%（387例患者）。中位手术时间为617分钟（第10百分位数-第90百分位数；456-834分钟），中位失血量为160克（第10百分位数-第90百分位数；30-558克）。并发症发生率（Clavien-Dindo分级≥Ⅲa级）为20.5%。30天和90天死亡率分别为0.2%和0.5%。
结论
我们的结果表明，RPD可以成功引入，是一种有前景的胰十二指肠切除手术方法。
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