Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2023-10-25 DOI:10.1002/jhbp.1383

Bor-Shiuan Shyr, Yi-Ming Shyr, Shih-Chin Chen, Shin-E Wang, Bor-Uei Shyr

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引用次数: 0

Abstract

Background

The role of the robotic approach for pancreaticoduodenectomy has not been well established with robust data. This study aimed to reappraise feasibility and justification of robotic pancreaticoduodenectomy (RPD) over time.

Methods

A total of 500 patients undergoing RPD were enrolled and divided into early (first 250 patients) and late (last 250 patients) groups for a comparative study.

Results

The conversion rate was 8.8% overall and was significantly lower in the late group (5.6% vs. 12.0%; p = .012). The overall median intraoperative blood loss was 130 mL. Radicality of resection was similar between early and late groups. The overall surgical mortality after RPD was 1.3%. The overall surgical morbidity and major complication was 44.1% and 13.2%, respectively, and similar between early and late groups. Chyle leakage was the most common complication after RPD (25.0%), followed by postoperative pancreatic fistula (POPF). The POPF rate was 8.6% overall, with 5.9% in the early group and 11.0% in the late group, p = .051. The overall delayed gastric emptying rate was 3.5%. The late group had better survival outcomes than those of the early group after RPD for ampullary adenocarcinoma (p = .027) but not for pancreatic head adenocarcinoma.

Conclusions

Reappraisal of this study has confirmed that RPD is not only technically feasible without increasing surgical risks but also oncologically justified without compromising survival outcomes for both pancreatic head and other periampullary cancers over time. Moreover, RPD is associated with the benefits of low surgical mortality, blood loss, and delayed gastric emptying.

Abstract Image

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连续500例机器人胰十二指肠切除术的手术和生存结果的再评价。

背景：机器人入路在胰十二指肠切除术中的作用尚未得到很好的证实，也没有可靠的数据。本研究旨在随着时间的推移重新评估机器人胰十二指肠切除术（RPD）的可行性和合理性。方法：共有500名接受RPD的患者被纳入研究，并分为早期（前250名患者）和晚期（后250名）两组进行比较研究。结果：总的转化率为8.8%，晚期组的转化率明显较低（5.6%vs.12.0%；p = .012）。术中总体平均失血量为130 mL。早期组和晚期组的切除半径相似。RPD后的总手术死亡率为1.3%。总手术发病率和主要并发症分别为44.1%和13.2%，早期组和晚期组相似。Chyle渗漏是RPD术后最常见的并发症（25.0%），其次是术后胰瘘（POPF）。POPF的总体发生率为8.6%，早期组为5.9%，晚期组为11.0%，p = .总的胃排空延迟率为3.5%。壶腹腺癌RPD后，晚期组的生存结果优于早期组（p = .027），但不适用于胰头腺癌。结论：对这项研究的重新评估证实，RPD不仅在技术上可行，不会增加手术风险，而且在肿瘤学上是合理的，不会随着时间的推移影响胰头癌和其他壶腹周围癌的生存结果。此外，RPD与低手术死亡率、失血和胃排空延迟有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.