文章：

胰腺癌微创胰十二指肠切除术中动脉优先入路：单中心结果及腹腔镜与机器人入路对比

Artery-First Approach During Minimally Invasive Pancreatoduodenectomy for Pancreatic Cancer: Outcomes from a Single Center and Comparison Between Laparoscopic and Robotic Approaches

原文发布日期：23 June 2025

DOI: 10.3390/cancers17132103

类型: Article

开放获取: 是

英文摘要：

Background:Despite benefits during open pancreatoduodenectomy (PD), the artery-first approach (AFA) during minimally invasive PD (MIPD) has been poorly investigated.Methods:Data of consecutive patients undergoing MIPD (both laparoscopic (LPD) and robotic (RPD)) from 2020 to 2024 for pancreatic cancer (PC) were prospectively collected and retrospectively analyzed, comparing the surgical and oncological outcomes of LPD with right AFA and RPD with posterior AFA. The rate of ineffective AFA (IAFA), defined in the case of excessive resection time, estimated blood loss, or conversion to laparotomy, was also investigated.Results:71 patients undergoing MIPD were selected (32 LPD and 39 RPD). Baseline patients’ characteristics only differed for a higher rate of neoadjuvant treatment in LPD and RPD groups, respectively (23.1% vs. 0%,p= 0.0036). No patients underwent conversion. R0 resection was obtained in 74.6% of patients. No difference between the groups was found regarding intraoperative, postoperative, and oncological outcomes except for a greater number of lymph nodes harvested in RPD (24 vs. 17,p= 0.023). IAFA was observed in 12.7% of patients, without difference between the groups (9.4 vs. 15.4%,p= 0.499, in LPD and RPD, respectively).Conclusions:MIPD with AFA was feasible and safe in patients affected by PC. RPD using posterior AFA had a higher number of lymph nodes retrieved when compared to LPD using right AFA. RPD has provided subjective advantages for the surgeon in terms of handling, safety, and reproducibility, although these have not translated into better outcomes.

摘要翻译： 

背景：尽管动脉优先入路（AFA）在开放式胰十二指肠切除术（PD）中具有优势，但其在微创胰十二指肠切除术（MIPD）中的应用研究尚不充分。方法：前瞻性收集并回顾性分析了2020年至2024年间连续接受MIPD（包括腹腔镜胰十二指肠切除术（LPD）和机器人胰十二指肠切除术（RPD））治疗胰腺癌（PC）的患者数据，比较了采用右侧AFA的LPD与采用后方AFA的RPD的手术及肿瘤学结果。同时，还探讨了无效AFA（IAFA）的发生率，其定义为手术时间过长、估计失血量过多或中转开腹的情况。结果：共纳入71例接受MIPD的患者（32例LPD，39例RPD）。两组患者的基线特征仅在LPD组和RPD组的新辅助治疗率上存在差异（分别为23.1% vs. 0%，p=0.0036）。无患者中转开腹。R0切除率为74.6%。除RPD组获取的淋巴结数量更多（24枚 vs. 17枚，p=0.023）外，两组在术中、术后及肿瘤学结果方面均无差异。IAFA发生率为12.7%，两组间无统计学差异（LPD组9.4% vs. RPD组15.4%，p=0.499）。结论：对于PC患者，采用AFA的MIPD是可行且安全的。与采用右侧AFA的LPD相比，采用后方AFA的RPD能够获取更多数量的淋巴结。尽管未转化为更好的临床结局，但RPD在操作便利性、安全性和可重复性方面为外科医生提供了主观优势。

原文链接：

Artery-First Approach During Minimally Invasive Pancreatoduodenectomy for Pancreatic Cancer: Outcomes from a Single Center and Comparison Between Laparoscopic and Robotic Approaches