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Title: [Robotic versus laparoscopic distal pancreatectomy: a retrospective single-center study].
Author: Lin XC, Huang HG, Chen YC, Lu FC, Lin RG, Yang YY, Wang CF, Fang HZ.
Journal: Zhonghua Wai Ke Za Zhi; 2019 Feb 01; 57(2):102-107. PubMed ID: 30704212.
Abstract:
Objective: To compare the short-term clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). Methods: The retrospective descriptive study was adopted.The clinical data of 158 patients underwent minimally invasive distal pancreatectomy who were admitted to Fujian Medical University Union Hospital between January 2016 and July 2018 were collected.A 1∶1 matched propensity score (PSM) analysis was performed for the RDP group and the LDP group.Observed indexes included operative time, blood loss, spleen-preserving rate, postoperative hospital stay, morbidity, incidence of pancreatic fistula and hospital costs. T test or rank sum test was used to compare measurement data, χ(2) test or Fisher exact test was used to compare count data. Results: A well-balanced cohort of 41 patients was analyzed.There were 14 males and 27 females in the RDP group, aged (45.2±16.4)years. There were 15 males and 26 females in the LDP group, aged (47.4±14.9) years.The operation time was (209.7±52.9) minutes for the RDP group and (186.5±56.7) minutes for the LDP group (P=0.073). Median blood loss was less in RDP (50(15-175)ml) compared with LDP (100(50-350)ml) (Z=-2.689, P=0.007). Thirty-eight cases of non-malignant diseases were observed in each group and spleen-preserving rate was higher in RDP (76.3%) compared to LDP(44.7%) (χ(2)=7.930, P=0.005).Postoperative hospital stay was similar in the RDP group and the LDP group (RDP: 9.4 days vs. LDP: 10.6 days; P=0.372). The overall morbidity and incidence of pancreatic fistula major complication rates (RDP: 12.2% vs. LDP: 14.6%, P=0.746; RDP: 7.3% vs. LDP: 9.8%, P=1.000) were similar.Total cost of RDP group was higher than that of LDP group ((80 563.7±10 641.8) yuan vs. (57 792.8±8 943.0) yuan, t=4.515, P<0.01). Conclusions: Both RDP and LDP are safe and feasible procedures. RDP is more expensive, but RDP is associated with significantly less blood loss and higher spleen-preserving rate, which is more suitable for the non-malignant diseases of pancreatic body and tail with an expectation of splenic preservation. 目的： 比较机器人与腹腔镜胰体尾切除术的短期临床结果及住院费用。 方法： 采用回顾性队列研究。收集2016年1月至2018年7月福建医科大学附属协和医院基本外科施行的158例微创胰体尾切除术患者的临床资料。使用倾向评分匹配（PSM）方法对机器人胰体尾切除术组（RDP组）和腹腔镜胰体尾切除术组（LDP组）患者进行1∶1匹配。主要观察指标：手术时间、术中出血量、保脾情况、术后住院时间、并发症发生率、胰瘘发生率、住院费用等。计量资料的比较采用t检验或秩和检验，计数资料的比较采用χ(2)检验或Fisher确切概率法。 结果： 经PSM方法匹配后RDP组和RDP组各41例患者。RDP组中男性14例，女性27例，年龄（45.2±16.4）岁；LDP组中男性15例，女性26例，年龄（47.4±14.9）岁。RDP组手术时间为（209.7±52.9）min，LDP组为（186.5±56.7）min，两组差异无统计学意义（P=0.073）。RDP组中位术中出血量[50（15~175）ml]少于LDP组[100（50~350）ml]（Z=-2.689，P=0.007）。两组非恶性病例均为38例，RDP组保脾率为76.3%（29/38），高于LDP组的44.7%（17/38）（χ(2)=7.930，P=0.005）。RDP组（9.4 d）和LDP组（10.6 d）术后住院时间的差异无统计学意义（P=0.372）。两组患者术后并发症发生率（RDP组12.2%，LDP组14.6%，P=0.746）和胰瘘发生率（RDP组7.3%，LDP组9.8%，P=1.000）的差异亦无统计学意义。RDP组的住院费用[（80 563.7±10 641.8）元]较LDP组[（57 792.8±8 943.0）元]高（t=4.515，P<0.01）。 结论： RDP和LDP均安全可行，RDP虽然增加了住院费用，但术中出血量更少、保脾率更高，对于希望保留脾脏的胰体尾非恶性肿瘤患者宜选择RDP。.

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