Background: The robotic approach is an appealing way to perform minimally invasive pancreaticoduodenectomy. We compare robotic cases’ short-term and oncological outcomes to a historical cohort of open cases.Methods: Data were collected in a prospective database between 2016 and 2024; complications were graded using the ISGPS definition for the specific pancreas-related complications and the Clavien–Dindo classification for overall complications. Furthermore, the Comprehensive Complication Index was calculated. All patients undergoing pancreaticoduodenectomy were included, except those with acute or chronic pancreatitis, vascular tumour involvement or multi-visceral resections. Only the subset of patients with malignancy was regarded for the oncologic outcome.Results: In total, 100 robotic and 102 open pancreaticoduodenectomy cases are included. Equal proportions of patients have a main pancreatic duct ≤3 mm (p= 1.00) and soft consistency of the pancreatic remnant (p= 0.78). Surgical time is longer for robotic pancreaticoduodenectomy (p< 0.01), and more patients have delayed gastric emptying (44% and 28.4%,p= 0.03). In the robotic group, the number of patients without any postoperative complications is higher (p= 0.02), and there is less chyle leak (p< 0.01). Ninety-day mortality, postoperative pancreatic fistula, and postpancreatectomy haemorrhage are similar. The lymph node retrieval and R0 resection rates are comparable.Conclusions: In conclusion, after robotic pancreaticoduodenectomy, remembering all cases during the learning curve are included, less chyle leak is observed, the proportion of patients without any complication is significantly larger, the surgical duration is longer, and more patients have delayed gastric emptying. Oncological results, i.e., lymph node yield and R0 resection rate, are comparable to open pancreaticoduodenectomy.
背景：机器人辅助手术是实施微创胰十二指肠切除术的一种引人注目的方式。本研究将机器人手术病例的短期及肿瘤学结局与历史开放性手术队列进行比较。 方法：数据收集自2016年至2024年的前瞻性数据库；并发症分级采用国际胰腺外科研究组（ISGPS）定义的胰腺特异性并发症标准，以及Clavien-Dindo分级系统评估总体并发症。此外，计算了综合并发症指数。研究纳入所有接受胰十二指肠切除术的患者，排除急性或慢性胰腺炎、肿瘤侵犯血管或多脏器联合切除病例。仅对恶性肿瘤患者亚组进行肿瘤学结局分析。 结果：共纳入100例机器人手术和102例开放手术病例。两组中主胰管直径≤3 mm（p=1.00）及胰腺残端质地柔软（p=0.78）的患者比例相当。机器人手术时间更长（p<0.01），胃排空延迟发生率更高（44% vs 28.4%，p=0.03）。机器人组无任何术后并发症的患者比例更高（p=0.02），乳糜漏发生率更低（p<0.01）。两组90天死亡率、术后胰瘘及胰腺切除术后出血发生率相似。淋巴结清扫数目和R0切除率具有可比性。 结论：综上所述，在包含学习曲线全部病例的情况下，机器人胰十二指肠切除术术后乳糜漏发生率更低，无并发症患者比例显著更高，但手术时间更长且胃排空延迟更常见。其肿瘤学结果（淋巴结获取数量与R0切除率）与开放手术相当。
Robotic Pancreaticoduodenectomy for Pancreatic Head Tumour: A Single-Centre Analysis
肿瘤(癌症)患者之家