机器人与开放式胰十二指肠切除术的胰瘘发生率降低及综合成本分析。

IF 2.4 2区 医学 Q2 SURGERY
Taiga Wakabayashi, Federico Gaudenzi, Yusuke Nie, Kohei Mishima, Yoshiki Fujiyama, Kazuharu Igarashi, Yu Teshigahara, Sho Mineta, Emre Bozkurt, Go Wakabayashi
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引用次数: 0

摘要

背景:机器人胰十二指肠切除术(RPD)已成为治疗壶腹周围肿瘤的一种很有前途的手术方法,提供了微创手术的潜在优势。然而,与开放式胰十二指肠切除术(OPD)相比,RPD对临床相关胰瘘(CR-PF)发生率和总成本的影响尚不清楚,限制了其广泛采用。方法:本回顾性队列研究于2017年至2023年在日本一家大容量转诊中心进行。共有193例壶腹周围肿瘤患者接受了RPD (n = 81)或OPD (n = 112)。为了解释潜在的选择偏差,使用倾向评分匹配(PSM)来平衡患者人口统计学和临床特征,产生两个匹配良好的组,每组60例患者。评估围手术期预后、CR-PF率和综合成本分析。结果:RPD组CR-PF发生率(10%)明显低于OPD组(33.3%)(p = 0.003)。此外,与OPD组(22.5天)相比,接受RPD的患者住院时间(15天)更短(p)。结论:与OPD组相比,RPD具有显著的临床优势,包括更低的CR-PF率和更短的住院时间,而不增加总体医院费用。这些发现支持了在临床实践中采用RPD治疗壶腹周围肿瘤的可行性和潜在益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reduced pancreatic fistula rates and comprehensive cost analysis of robotic versus open pancreaticoduodenectomy.

Background: Robotic pancreaticoduodenectomy (RPD) has emerged as a promising surgical approach for the treatment of periampullary neoplasms, offering the potential benefits of minimally invasive surgery. However, the impact of RPD on clinically relevant pancreatic fistula (CR-PF) rates and overall costs compared to open pancreaticoduodenectomy (OPD) remains unclear, limiting its widespread adoption.

Methods: This retrospective cohort study was conducted at a high-volume Japanese referral center from 2017 to 2023. A total of 193 patients diagnosed with periampullary neoplasms underwent either RPD (n = 81) or OPD (n = 112). To account for potential selection bias, propensity score matching (PSM) was used to balance patient demographics and clinical characteristics, resulting in two well-matched groups of 60 patients each. Perioperative outcomes, CR-PF rates, and a comprehensive cost analysis were evaluated.

Results: RPD resulted in a significantly lower rate of CR-PF (10%) compared to OPD (33.3%) (p = 0.003). Additionally, patients who underwent RPD experienced shorter hospital stays (15 days) compared to those in the OPD group (22.5 days) (p < 0.001). Despite longer operative times for RPD (633 vs. 395 min; p < 0.001), total hospital costs were comparable between the two groups. The higher operative costs associated with RPD were offset by reduced postoperative complications and shorter hospitalization.

Conclusions: RPD offers significant clinical advantages, including lower CR-PF rates and reduced hospital stays, without increasing overall hospital costs compared to OPD. These findings support the feasibility and potential benefits of adopting RPD for the management of periampullary neoplasms in clinical practice.

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来源期刊
CiteScore
6.10
自引率
12.90%
发文量
890
审稿时长
6 months
期刊介绍: Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research. Topics covered in the journal include: -Surgical aspects of: Interventional endoscopy, Ultrasound, Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology, -Gastroenterologic surgery -Thoracic surgery -Traumatic surgery -Orthopedic surgery -Pediatric surgery
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