Robotic approach mitigates the effect of major complications on survival after pancreaticoduodenectomy for periampullary cancer,Surgical Endoscopy

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Robotic approach mitigates the effect of major complications on survival after pancreaticoduodenectomy for periampullary cancer
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-09-26 , DOI: 10.1007/s00464-022-09638-4
Thiagarajan Meyyappan ₁ , Greg C Wilson ₂ , Herbert J Zeh ₃ , Melissa E Hogg ₄ , Kenneth K Lee ₁ , Amer H Zureikat ₁ , Alessandro Paniccia ₁

Affiliation

Background

Major complications (MCs) after pancreaticoduodenectomy (PD) are a known independent predictor of worse oncologic outcomes. There are limited data on the effect of major complications on long-term outcomes after robotic PD (RPD). The aim of this study is to compare the effect of MC on overall (OS) and disease-free survival (DFS) after RPD and open PD (OPD).

Methods

This is a single-center, retrospective review of a prospectively maintained database of all patients undergoing PD for periampullary cancer including ampullary adenocarcinoma, distal cholangiocarcinoma, and duodenal carcinoma. Univariate analysis was performed on all clinical, pathologic, and treatment factors. MCs were defined as Clavien-Dindo ≥ grade 3. Kaplan–Maier survival analysis was performed with log-rank test for group comparison. Multivariable Cox regression analysis was used to identify factors associated with overall survival (OS) in both the OPD and RPD groups.

Results

A total of 190 patients with ampullary carcinoma (n = 98), cholangiocarcinoma (n = 55), and duodenal adenocarcinoma (n = 37) were examined over the study period with 61.1% (n = 116) undergoing RPD and 38.9% (n = 74) undergoing OPD. There was no significant difference in patient demographics between the RPD and OPD cohorts. Furthermore, R0 resection rates, tumor size, and lymph node involvement were similar between the RPD and OPD cohorts. OPD had higher rate of MC (40.5% vs 28.3% in RPD, p = 0.011) including clinically relevant pancreatic fistula (25.7% vs 8.6%, p = 0.001) and wound infection (34.5% vs 13.8%, p < 0.001). MCs were associated with a lower OS in the OPD cohort (HR = 2.18, 95%CI 1.0–4.55, p = 0.038). MCs were not associated with OS in the RPD cohort (HR = 1.55, 95%CI 0.87–2.76, p = 0.14).

Conclusion

MCs are associated with worse patient outcomes after OPD but not after RPD. Robotic approach mitigates and possibly abrogates the negative effects of MCs on patient outcomes after PD for malignancy and is associated with improved adjuvant chemotherapy completion rates.

Graphical abstract

中文翻译：

机器人方法减轻壶腹周围癌胰十二指肠切除术后主要并发症对生存的影响

背景

胰十二指肠切除术 (PD) 后的主要并发症 (MC) 是肿瘤预后较差的已知独立预测因素。关于机器人 PD (RPD) 后主要并发症对长期结果影响的数据有限。本研究的目的是比较 MC 对 RPD 和开放性 PD (OPD) 后总体 (OS) 和无病生存 (DFS) 的影响。

方法

这是一项单中心回顾性研究，对所有接受壶腹周围癌（包括壶腹腺癌、远端胆管癌和十二指肠癌）接受 PD 的患者的前瞻性数据库进行了回顾性审查。对所有临床、病理和治疗因素进行单变量分析。 MC 被定义为 Clavien-Dindo ≥ 3 级。通过对数秩检验进行 Kaplan-Maier 生存分析以进行组间比较。多变量 Cox 回归分析用于确定 OPD 和 RPD 组中与总生存 (OS) 相关的因素。

结果

在研究期间，共有 190 名壶腹癌 ( n = 98)、胆管癌 ( n = 55) 和十二指肠腺癌 ( n = 37) 患者接受了检查，其中 61.1% ( n = 116) 接受了 RPD，38.9% ( n = 116) 接受了 RPD 治疗。 = 74) 正在接受 OPD。 RPD 和 OPD 队列之间的患者人口统计数据没有显着差异。此外，RPD 和 OPD 队列之间的 R0 切除率、肿瘤大小和淋巴结受累情况相似。 OPD 的 MC 发生率较高（40.5% vs 28.3%，RPD， p = 0.011），包括临床相关胰瘘（25.7% vs 8.6%， p = 0.001）和伤口感染（34.5% vs 13.8%， p < 0.001）。 MC 与 OPD 队列中较低的 OS 相关（HR = 2.18，95% CI 1.0–4.55， p = 0.038）。 RPD 队列中 MC 与 OS 无关（HR = 1.55，95% CI 0.87–2.76， p = 0.14）。