微创胰十二指肠切除术的陷阱。

Annals of Pancreatic Cancer Pub Date : 2019-01-01 Epub Date: 2019-01-16 DOI:10.21037/apc.2018.12.02
Patrick W Underwood, Michael H Gerber, Steven J Hughes
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引用次数: 5

摘要

与开放入路相比,微创入路腹部外科手术提供了更好的结果,因此已成为标准的护理方法。然而,微创胰十二指肠切除术(MIPD)在腹腔镜和机器人平台上都存在独特的困难,并且仍然存在争议。当全系统数据表明在学习过程中,MIPD会导致发病率和死亡率增加时,人们对微创方法能否产生有意义的益处的关注仍在继续。这篇论文探讨了MIPD的现状,回顾了支持益处的数据的数量和质量,同时对比了与MIPD相关的独特挑战的益处,这些挑战可能导致不可接受的并发症和死亡率。我们得出的结论是,在少数中心,MIPD提供了迭代而不是变革性的好处。广泛接受MIPD的重大障碍是明显且持续存在的,包括:缺乏证实临床益处的高水平数据,明确定义的患者选择标准,解决学习曲线挑战的正规教育计划,以及最终的价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Pitfalls of minimally invasive pancreatoduodenectomy.

Pitfalls of minimally invasive pancreatoduodenectomy.

Minimally invasive approaches to abdominal surgical procedures have provided superior outcomes when compared to the open approach and thus have become the standard of care. However, minimally invasive pancreatoduodenectomy (MIPD) presents unique difficulties for both laparoscopic and robotic platforms and remains controversial. Ongoing concerns continue about the minimally invasive approach creating meaningful benefit when system-wide data may suggest MIPD results in increased morbidity and mortality during the learning curve. This treatise explores the current state of MIPD, reviewing the volume and quality of data that supports benefit while contrasting the benefits to the unique challenges associated with MIPD that may lead to unacceptable rates of complications and death. We conclude that in a handful of centers, MIPD confers an iterative but not transformative benefit. Significant barriers to the wide-spread acceptance of MIPD are apparent and persist, including: lack of high level data confirming clinical benefit, well defined patient selection criteria, formal education programs that address challenges of the learning curve, and ultimately value.

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