医学
淋巴结切除术
外科
腹腔镜手术
腹腔镜检查
开放手术
机械人手术
吻合
临床终点
癌症
内科学
随机对照试验
作者
Francesca Ratti,Francesco Cipriani,Sara Ingallinella,Antonella Tudisco,Marco Catena,Luca Aldrighetti
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2022-11-07
卷期号:278 (4): e780-e788
被引量:7
标识
DOI:10.1097/sla.0000000000005748
摘要
Objective: This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumors and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches and to compare the techniques within a weighted propensity score analysis. Background: The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery. Methods: Overall, 25 robotic resections with LND (2021-2022) from a single-center constituted the study group (Rob group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap group) and 113 open (Open group) procedures to address the primary endpoint. A “per-period” analysis was performed comparing the characteristics and outcomes of the Rob group with the first 25 consecutive laparoscopic liver resections with associated LND (LapInit group). Results: Minimally invasive techniques performed equally well regarding the number of harvested nodes, blood transfusions, functional recovery, length of stay, and major morbidity and provided a short-term benefit to patients when compared with the open technique. A better performance of the robotic approach over laparoscopic approach (and both approaches over the open technique) was recorded for patients achieving LND with retrieval of >6 nodes. The open approach reduced both the operative time and time for LND, and robotic surgery performed better than laparoscopic surgery. Conclusions: Minimally invasive techniques are excellent tools for the management of LND in patients with biliary tumors, showing feasibility, and oncological adequacy. Robotics could contribute to the large-scale diffusion of these procedures with a high profile of complexity.
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