肥胖患者中机器人辅助与腹腔镜辅助的远端胰腺切除术比较。
Robotic versus laparoscopic distal pancreatectomy in obese patients.
发表日期：2023 Sep 15
作者：
Fabio Ausania, Filippo Landi, John B Martinie, Dionisios Vrochides, Matthew Walsh, Shanaz M Hossain, Steven White, Viswakumar Prabakaran, Laleh G Melstrom, Yuman Fong, Giovanni Butturini, Laura Bignotto, Valentina Valle, Yuntao Bing, Dianrong Xiu, Gregorio Di Franco, Francisco Sanchez-Bueno, Nicola de'Angelis, Alexis Laurent, Giuseppe Giuliani, Graziano Pernazza, Alessandro Esposito, Roberto Salvia, Francesca Bazzocchi, Ludovica Esposito, Andrea Pietrabissa, Luigi Pugliese, Riccardo Memeo, Ichiro Uyama, Yuichiro Uchida, José Rios, Andrea Coratti, Luca Morelli, Pier C Giulianotti
来源：
CLINICAL PHARMACOLOGY & THERAPEUTICS
摘要：
尽管机器人脾病远端切除手术（RDP）的开转换率较低，失血量也较腹腔镜脾病远端切除手术（LDP）少，但关于手术方式对并发症影响的确凿证据尚缺乏。既往研究表明，肥胖患者接受胰腺切除术的并发症率较高。本研究的主要目的是比较BMI≥30的患者的RDP和LDP的短期结果。在这项多中心研究中，将2012年至2022年期间在18个国际专家中心接受任何指征下RDP或LDP手术的所有肥胖患者纳入研究。基线特征经过逆概率处理加权以减少分配偏倚。446名患者中，219名（50.2%）接受了RDP。中位年龄为60岁，中位BMI为33（31-36），术前诊断为21%的导管腺癌。转化率为19.9%，总并发症率为57.8%，90天死亡率为0.7%（3名患者）。与LDP相比，RDP与较低的并发症率（OR 0.68，95% CI 0.52-0.89；p=0.005），更低的失血量（150 vs. 200 ml；p<0.001），更少的输血需求（OR 0.28，95% CI 0.15-0.50；p<0.001）和较低的综合并发症指数（8.7 vs. 8.9；p<0.001）相关。与LDP相比，RDP具有较低的转化率（OR 0.27，95% CI 0.19-0.39；p<0.001）和较好的脾保留率（OR 1.96，95% CI 1.13-3.39；p=0.016）。在肥胖患者中，RDP与较低的转化率、较少的并发症和更好的短期结果相关。© 2023. 作者.
Although robotic distal pancreatectomy (RDP) has a lower conversion rate to open surgery and causes less blood loss than laparoscopic distal pancreatectomy (LDP), clear evidence on the impact of the surgical approach on morbidity is lacking. Prior studies have shown a higher rate of complications among obese patients undergoing pancreatectomy. The primary aim of this study is to compare short-term outcomes of RDP vs. LDP in patients with a BMI ≥ 30.In this multicenter study, all obese patients who underwent RDP or LDP for any indication between 2012 and 2022 at 18 international expert centers were included. The baseline characteristics underwent inverse probability treatment weighting to minimize allocation bias.Of 446 patients, 219 (50.2%) patients underwent RDP. The median age was 60 years, the median BMI was 33 (31-36), and the preoperative diagnosis was ductal adenocarcinoma in 21% of cases. The conversion rate was 19.9%, the overall complication rate was 57.8%, and the 90-day mortality rate was 0.7% (3 patients). RDP was associated with a lower complication rate (OR 0.68, 95% CI 0.52-0.89; p = 0.005), less blood loss (150 vs. 200 ml; p < 0.001), fewer blood transfusion requirements (OR 0.28, 95% CI 0.15-0.50; p < 0.001) and a lower Comprehensive Complications Index (8.7 vs. 8.9, p < 0.001) than LPD. RPD had a lower conversion rate (OR 0.27, 95% CI 0.19-0.39; p < 0.001) and achieved better spleen preservation rate (OR 1.96, 95% CI 1.13-3.39; p = 0.016) than LPD.In obese patients, RDP is associated with a lower conversion rate, fewer complications and better short-term outcomes than LPD.© 2023. The Author(s).