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Outcomes of Robotic Versus Laparoscopic Pancreatoduodenectomy Following Learning Curves of Surgeons

医学 倾向得分匹配 围手术期 失血 外科 输血 存活率 单中心
作者
Xiuping Zhang,Shuai Xu,Zhiming Zhao,Guangsheng Yu,Bing Han,Xiong Chen,Wei Ma,Zongzhen Xu,Zhao Liu,En-Shan Li,Xiang-Feng Guo,Yuan-Xing Gao,Guodong Zhao,Wan Yee Lau,Jun Liu,Rong Liu
出处
期刊:Annals of Surgery [Ovid Technologies (Wolters Kluwer)]
被引量:3
标识
DOI:10.1097/sla.0000000000006167
摘要

Objective: This study aimed to compare robotic pancreatoduodenectomy (RPD) with laparoscopic pancreatoduodenectomy (LPD) in operative and oncologic outcomes. Background: Previous studies comparing RPD with LPD have only been carried out in small, single-center studies with variable quality. Methods: Consecutive patients from nine centers in China who underwent RPD or LPD between 2015 and 2022 were included. A 1:1 propensity score matching (PSM) was used to minimize bias. Results: Of the 2,255 patients, 1158 underwent RPD and 1097 underwent LPD. Following PSM, 1006 patients were enrolled in each group. The RPD group had significantly shorter operative time (270.0 vs. 305.0 minutes, P <0.001), lower intraoperative blood transfusion rate (5.9% vs. 12.0%, P <0.001), lower conversion rate (3.8% vs. 6.7%, P =0.004), and higher vascular reconstruction rate (7.9% vs. 5.6%, P =0.040) than the LPD group. There were no significant differences in estimated blood loss, postoperative length of stay, perioperative complications, and 90-day mortality. Patients who underwent vascular reconstruction had similar outcomes between the two groups, although they had significantly lower estimated blood loss (300.0 vs. 360.0 mL; P =0.021) in the RPD group. Subgroup analysis on pancreatic ductal adenocarcinoma (PDAC) found no significant differences between the two groups in median recurrence-free survival (14.3 vs. 15.3 mo, P =0.573) and overall survival (24.1 vs. 23.7 mo, P =0.710). Conclusions: In experienced hands, both RPD and LPD are safe and feasible procedures with similar surgical outcomes. RPD had the perioperative advantage over LPD especially in vascular reconstruction. For PDAC patients, RPD resulted in similar oncological and survival outcomes as LPD.
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