机器人、腹腔镜和开放式胰十二指肠切除术治疗壶腹腺癌的肿瘤切除和围手术期结果：一项倾向评分匹配的国际多中心队列研究

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-03-01 DOI:10.1016/j.hpb.2024.11.013

Bas A. Uijterwijk , Alma Moekotte , Ugo Boggi , Michele Mazzola , Bas Groot Koerkamp , Raffaele Dalle Valle , Sharnice Koek , Louisa Bolm , Alessandro Mazzotta , Misha Luyer , Brian K.P. Goh , Miguel A. Suarez Muñoz , Bergthor Björnsson , Geert Kazemier , Benedetto Ielpo , Patrick Pessaux , Jorg Kleeff , Poya Ghorbani , Vasileios K. Mavroeidis , Giuseppe K. Fusai , Brett Ecker

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引用次数: 0

摘要

背景：腹部腺癌（AAC）通常表现为早期胆道梗阻，因此可能特别适合微创胰十二指肠切除术（MIPD）。然而，专门针对AAC评估MIPD的研究，包括机器人和腹腔镜方法，是有限的。本研究的目的是比较机器人（RPD）、腹腔镜（LPD）和开放式胰十二指肠切除术（OPD）针对AAC的短期和长期肿瘤切除术和围手术期结果。方法在这项多中心国际队列研究中，包括来自11个国家的35个中心，进行了MIPD与OPD以及LPD与RPD的亚组分析。主要结局为肿瘤切除（R1切除率、淋巴结生成率）和5年总生存期。次要结局是围手术期结局（包括术中变量、手术并发症和住院时间）。结果共有1721例AAC患者接受了OPD或MIPD（141例）。倾向评分匹配后，每个队列纳入134例患者。MIPD组包括53例rpd和71例lpd （PSM后每组50例）。MIPD和OPD的总生存率无差异（61.6% vs 56.2%, P = 0.215）。MIPD组手术时间更长(439 vs 360 min, P <；0.001)。在RPD和LPD之间，总生存率无显著差异（75.8% vs 47.4%, P = 0.098）， RPD的淋巴结清扫率更高（21 vs 18, P = 0.014）。总之，与传统的OPD相比，MIPD的AAC患者似乎具有相当的肿瘤切除和围手术期预后。对于AAC患者，RPD和LPD似乎都是安全的选择，这需要未来的随机研究来证实。

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Oncological resection and perioperative outcomes of robotic, laparoscopic and open pancreatoduodenectomy for ampullary adenocarcinoma: a propensity score matched international multicenter cohort study

Background

Ampullary adenocarcinoma (AAC) typically presents at an early stage due to biliary obstruction and therefore might be specifically suitable for minimally invasive pancreatoduodenectomy (MIPD). However, studies assessing MIPD specifically for AAC, including the robotic and laparoscopic approach, are limited. The aim of this study is to compare short- and long-term oncological resection and perioperative outcomes of robotic (RPD), laparoscopic (LPD) and open pancreatoduodenectomy (OPD) performed specifically for AAC.

Methods

In this multicenter international cohort study, encompassing 35 centers from 11 countries, MIPD versus OPD and subgroup analyses of LPD versus RPD were undertaken. The primary outcomes regarded the oncological resection (R1 resection rate, lymph node yield) and 5-years overall survival. Secondary outcomes were perioperative outcomes (including intra-operative variables, surgical complications and hospital stay).

Results

In total, patients with AAC who underwent OPD (1721) or MIPD (141) were included. After propensity-score matching, 134 patients per cohort were included. The MIPD group consisted of 53 RPDs and 71 LPDs (50 per group after PSM). There was no difference in overall survival between MIPD and OPD (61.6 % vs 56.2 %, P = 0.215). In the MIPD group, operative time was longer (439 vs 360 min, P < 0.001). Between RPD and LPD, overall survival was not significantly different (75.8 % vs 47.4 %, P = 0.098) and lymph node yield was higher in RPD (21 vs 18, P = 0.014).

Conclusion

In conclusion, patients with AAC seem to have comparable oncological resection and perioperative outcomes from MIPD compared to the traditional OPD. Both RPD as LPD appear to be safe alternatives for patients with AAC, which warrants confirmation by future randomized studies.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).