Takagi Kosei, Yamada Motohiko, Fuji Tomokazu, Yasui Kazuya, Nishiyama Takeyoshi, Nagai Yasuo, Kanehira Noriyuki, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Surg Endosc. 2025 May;39(5):3137-3145. doi: 10.1007/s00464-025-11696-3. Epub 2025 Apr 4.
Difficulty scoring systems (DSS) have been developed to quantify the surgical complexity of laparoscopic distal pancreatectomy (LDP). However, few studies have validated these systems in the context of robotic distal pancreatectomy (RDP). Moreover, the impact of body composition on RDP outcomes remains unexplored. This study aimed to investigate the risk factors of surgical difficulty in RDP, including body composition.
This retrospective study included 72 consecutive patients who underwent RDP at our institution between April 2021 and October 2024. Using a modified DSS for LDP, patients were divided into three difficulty index groups. The association between the difficulty index and outcomes was investigated. Multivariate analyses were performed to identify risk factors associated with surgical difficulty (prolonged operative time) in RDP.
Patients were classified into three difficulty index groups: low (n = 28), intermediate (n = 25), and high (n = 19). Operative time was significantly associated with the surgical index (P = 0.01). Moreover, visceral fat area (VFA) was significantly correlated with operative time (r = 0.10, P = 0.008). The multivariate analyses found that VFA (≥ 100 cm) (odds ratio [OR] 5.03, 95% confidence interval [CI] 1.32-22.4, P = 0.02), malignancy (OR 4.92, 95% CI 1.50-18.9, P = 0.01), and pancreatic resection on the portal vein (OR 4.14, 95% CI 1.24-15.9, P = 0.02) were significant risk factors associated with surgical difficulty.
VFA could be a novel and useful factor for assessing the surgical difficulty associated with RDP.
已开发出难度评分系统（DSS）来量化腹腔镜远端胰腺切除术（LDP）的手术复杂性。然而，很少有研究在机器人远端胰腺切除术（RDP）的背景下验证这些系统。此外，身体成分对RDP结果的影响仍未得到探索。本研究旨在调查RDP手术难度的风险因素，包括身体成分。
这项回顾性研究纳入了2021年4月至2024年10月期间在本机构接受RDP的72例连续患者。使用改良的LDP DSS，将患者分为三个难度指数组。研究了难度指数与结果之间的关联。进行多变量分析以确定与RDP手术难度（手术时间延长）相关的风险因素。
患者分为三个难度指数组：低（n = 28）、中（n = 25）和高（n = 19）。手术时间与手术指数显著相关（P = 0.01）。此外，内脏脂肪面积（VFA）与手术时间显著相关（r = 0.10，P = 0.008）。多变量分析发现，VFA（≥100 cm）（优势比[OR] 5.03，95%置信区间[CI] 1.32 - 22.4，P = 0.02）、恶性肿瘤（OR 4.92，95% CI 1.50 - 18.9，P = 0.01）和门静脉胰腺切除术（OR 4.14，95% CI 1.24 - 15.9，P = 0.02）是与手术难度相关的显著风险因素。
VFA可能是评估与RDP相关手术难度的一个新的有用因素。
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