Background

Pancreaticoduodenectomy is performed using an open technique (OPD) as the gold standard. An increase in those performed laparoscopically (LPD) and robotically (RPD) are now reported. We compared the short-term outcomes of RPD cases with LPD and OPD.

Methods

A retrospective review of a prospectively collected database was undertaken of our first consecutive RPD, our first LPD and consecutive OPD cases. Those requiring venous and/or arterial resection were excluded.

Results

RPD (n = 25) had longer median operating times (461 (IQR 358–564) mins) than LPD (n = 41) (330 (IQR 262.5–397.5) mins) and OPD (n = 37) (330 (IQR 257–403) mins, p < 0.0001). Estimated blood loss and transfusion requirement was less after RPD and LPD compared to OPD (p = 0.012 and p < 0.0001 respectively). No RPD cases required conversion to open operation compared to 24.4% of LPD. Morbidity was comparable with a Clavien Dindo score ≥3 in 20.00%, 24.39% and 18.92% for RPD, LPD and OPD respectively (p = 0.83). Post-operative pancreatic fistula rates were seen in 16.00%, 29.27% and 21.62% of our RPD, LPD and OPD cohorts respectively (p = 0.81). 90-day mortality was seen in 0.97% of the total cohort. Length of hospital stay (LOS) was shorter for RPD compared to both LPD (p = 0.030) and OPD (p = 0.002).

Conclusion

RPD is safe to perform with comparable outcomes to LPD and OPD. Further evidence is provided that a randomised controlled trial for PD techniques is required.

中文翻译：

---

英国三级转诊肝胆胰中心从开腹和腹腔镜手术到机器人胰十二指肠切除术的转变——机器人胰十二指肠切除术的早期经验

背景

胰十二指肠切除术采用开放式技术 (OPD) 作为金标准。现在报告了腹腔镜 (LPD) 和机器人 (RPD) 手术的增加。我们比较了 RPD 病例与 LPD 和 OPD 的短期结果。

方法

对前瞻性收集的数据库进行了回顾性审查，包括我们的第一个连续 RPD、我们的第一个 LPD 和连续 OPD 病例。那些需要静脉和/或动脉切除的患者被排除在外。

结果

RPD (n = 25) 的中位手术时间 (461 (IQR 358–564) 分钟) 比 LPD (n = 41) (330 (IQR 262.5–397.5) 分钟) 和 OPD (n = 37) (330 (IQR 257) 分钟–403) 分钟，p < 0.0001)。与 OPD 相比，RPD 和 LPD 后估计的失血量和输血需求较少（分别为 p = 0.012 和 p < 0.0001）。与 LPD 的 24.4% 相比，没有 RPD 案例需要转换为开放式操作。RPD、LPD 和 OPD 的发病率分别与 Clavien Dindo 评分≥3 的 20.00%、24.39% 和 18.92% 相当（p = 0.83）。在我们的 RPD、LPD 和 OPD 队列中，术后胰瘘发生率分别为 16.00%、29.27% 和 21.62%（p = 0.81）。90 天死亡率占总队列的 0.97%。与 LPD (p = 0.030) 和 OPD (p = 0.002) 相比，RPD 的住院时间 (LOS) 更短。

结论

RPD 是安全的，与 LPD 和 OPD 的结果相当。提供了进一步的证据表明需要对 PD 技术进行随机对照试验。