Background:Robotic-assisted pancreatoduodenectomy(RPD)has been widely performed in the treatment of pancreatic tumors.The oncologic outcome in the early stage of pancreatic ductal adenocarcinomas(PDAC)operated by RPD ...Background:Robotic-assisted pancreatoduodenectomy(RPD)has been widely performed in the treatment of pancreatic tumors.The oncologic outcome in the early stage of pancreatic ductal adenocarcinomas(PDAC)operated by RPD has not been evaluated.Methods:Clinical data of pathology confirmed stage I PDAC from January 2015 to December 2020 in Ruijin hospital,Shanghai Jiao Tong University School of Medicine was collected and retrospectively analyzed.Patients were divided into the open pancreaticoduodenectomy(OPD)group and the RPD group.Clinicopathological data and prognosis data were compared and analyzed.Results:A total of 426 patients were enrolled in this study,including 342 patients in the OPD group and 84 patients in the RPD group.The baseline characteristics of both groups were equivalent.Incidence of R1 resection was significantly lower in RPD group(3[3.6%]vs 40[11.7%],P=.044).RPD group was associated with better disease-free survival(DFS)and overall survival(OS)(DFS:Haszard Ratio[HR]:0.681,95%confidence interval[CI]:0.491-0.945,P=.022;OS:HR:0.667,95%CI:0.478-0.932,P=.017).T2 stage was associated with poor DFS and OS(DFS:HR:1.471,95%CI:1.092-1.981,P=.011;OS:HR:1.616,95%CI:1.209-2.160,P=.035).R1 resection was associated with poor OS(HR:1.483,95%CI:1.028-2.140,P=.035)while adjuvant therapy was associated with better OS(HR:0.589,95%CI:0.452-0.766,P<.001).Kaplan-Meier estimate showed significantly longer DFS and OS in RPD group(DFS:P=.004;OS:P=.009).Conclusion:For stage I PDAC patients,RPD surgery achieved higher R0 resection rates and better DFS and OS.T1 stage was associated with better DFS.R0 resection and adjuvant therapy were the accesses to better OS.展开更多
Background:Total pancreatectomy(TP)is a complex surgical procedure with significant postoperative morbidity.Despite the narrowed range of indications for TP,the introduction of neoadjuvant chemotherapy and the increas...Background:Total pancreatectomy(TP)is a complex surgical procedure with significant postoperative morbidity.Despite the narrowed range of indications for TP,the introduction of neoadjuvant chemotherapy and the increasing complexity of surgical resections performed in high-volume centers has increased the number of annually performed TPs,especially regarding malignant disease.The introduction of robotic-assisted pancreatic surgery has provided a novel and minimally invasive approach for TP,yet the feasibility of this technique is still unknown.This study assessed the safety and efficacy of robotic-assisted total pancreatectomy(RTP)compared to conventional open total pancreatectomy(OTP).Methods:All patients who underwent TP between March 2015 and July 2019 in a high-volume institution for pancreatic surgery were included in this retrospective study.Clinical data and perioperative outcomes were derived from the prospectively maintained institutional database.A 1:1 propensity score matching(PSM)method was utilized to compare the RTP and OTP cohorts to minimize bias.Results:A standardized surgical protocol was utilized for RTP following a learning curve of RPD and RDP.The median operative time for patients who underwent RTP was significantly decreased compared to those who underwent OTP[300(IQR,250-360)vs.360 min(IQR,300-525),P=0.031].Additionally,en bloc resection and spleen-preserving rates were also higher in the RTP cohort.Major 30-day morbidity(Clavien-Dindo>IIIa)and 90-day mortality were similar between the two cohorts.After a median follow-up time of 15(IQR,8-24)months,both the RTP and OTP cohorts had a comparable quality of life regarding exocrine and endocrine insufficiency.Conclusions:RTP appears to be safe and feasible when utilized in high-volume centers for the indicated management of benign and highly selected malignant pancreatic disease.However,further prospective randomized studies are needed to assess the feasibility of this approach.展开更多
基金funded in part by the Medical Engineering Cross Research Fund of Shanghai Jiao Tong University(no.YG2021QN16)Interdisciplinary Program of Shanghai Jiao Tong University(no.YG2019QNB26).
文摘Background:Robotic-assisted pancreatoduodenectomy(RPD)has been widely performed in the treatment of pancreatic tumors.The oncologic outcome in the early stage of pancreatic ductal adenocarcinomas(PDAC)operated by RPD has not been evaluated.Methods:Clinical data of pathology confirmed stage I PDAC from January 2015 to December 2020 in Ruijin hospital,Shanghai Jiao Tong University School of Medicine was collected and retrospectively analyzed.Patients were divided into the open pancreaticoduodenectomy(OPD)group and the RPD group.Clinicopathological data and prognosis data were compared and analyzed.Results:A total of 426 patients were enrolled in this study,including 342 patients in the OPD group and 84 patients in the RPD group.The baseline characteristics of both groups were equivalent.Incidence of R1 resection was significantly lower in RPD group(3[3.6%]vs 40[11.7%],P=.044).RPD group was associated with better disease-free survival(DFS)and overall survival(OS)(DFS:Haszard Ratio[HR]:0.681,95%confidence interval[CI]:0.491-0.945,P=.022;OS:HR:0.667,95%CI:0.478-0.932,P=.017).T2 stage was associated with poor DFS and OS(DFS:HR:1.471,95%CI:1.092-1.981,P=.011;OS:HR:1.616,95%CI:1.209-2.160,P=.035).R1 resection was associated with poor OS(HR:1.483,95%CI:1.028-2.140,P=.035)while adjuvant therapy was associated with better OS(HR:0.589,95%CI:0.452-0.766,P<.001).Kaplan-Meier estimate showed significantly longer DFS and OS in RPD group(DFS:P=.004;OS:P=.009).Conclusion:For stage I PDAC patients,RPD surgery achieved higher R0 resection rates and better DFS and OS.T1 stage was associated with better DFS.R0 resection and adjuvant therapy were the accesses to better OS.
基金This study is sponsored by the Guangci Outstanding Youth Training Program(GCQN-2017-B06)the Interdisciplinary Program of Shanghai Jiao Tong University(YG2019QNB26).
文摘Background:Total pancreatectomy(TP)is a complex surgical procedure with significant postoperative morbidity.Despite the narrowed range of indications for TP,the introduction of neoadjuvant chemotherapy and the increasing complexity of surgical resections performed in high-volume centers has increased the number of annually performed TPs,especially regarding malignant disease.The introduction of robotic-assisted pancreatic surgery has provided a novel and minimally invasive approach for TP,yet the feasibility of this technique is still unknown.This study assessed the safety and efficacy of robotic-assisted total pancreatectomy(RTP)compared to conventional open total pancreatectomy(OTP).Methods:All patients who underwent TP between March 2015 and July 2019 in a high-volume institution for pancreatic surgery were included in this retrospective study.Clinical data and perioperative outcomes were derived from the prospectively maintained institutional database.A 1:1 propensity score matching(PSM)method was utilized to compare the RTP and OTP cohorts to minimize bias.Results:A standardized surgical protocol was utilized for RTP following a learning curve of RPD and RDP.The median operative time for patients who underwent RTP was significantly decreased compared to those who underwent OTP[300(IQR,250-360)vs.360 min(IQR,300-525),P=0.031].Additionally,en bloc resection and spleen-preserving rates were also higher in the RTP cohort.Major 30-day morbidity(Clavien-Dindo>IIIa)and 90-day mortality were similar between the two cohorts.After a median follow-up time of 15(IQR,8-24)months,both the RTP and OTP cohorts had a comparable quality of life regarding exocrine and endocrine insufficiency.Conclusions:RTP appears to be safe and feasible when utilized in high-volume centers for the indicated management of benign and highly selected malignant pancreatic disease.However,further prospective randomized studies are needed to assess the feasibility of this approach.
