机器人胰腺实质保留手术与腹腔镜胰腺实质保留手术治疗胰腺神经内分泌肿瘤的效果比较

翁桂湖; 曹喆; 刘悦泽; 张太平

doi:10.12449/JCH250623

机器人胰腺实质保留手术与腹腔镜胰腺实质保留手术治疗胰腺神经内分泌肿瘤的效果比较

DOI: 10.12449/JCH250623

中国医学科学院北京协和医学院北京协和医院基本外科，北京 100730

基金项目:

国家自然科学基金 (82272917);

中央高水平医院临床研究专项 (2022-PUMCH-B-004)

伦理学声明：本研究方案于2023年11月23日经由中国医学科学院北京协和医学院北京协和医院伦理委员会审批，批号：I-23PJ2008。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：翁桂湖负责设计论文框架，起草论文；翁桂湖、刘悦泽负责数据收集，统计学分析，绘制图表；曹喆负责论文修改；张太平负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
张太平， tpingzhang@yahoo.com （ORCID： 0000-0003-1689-6908）

计量
- 文章访问数: 660
- HTML全文浏览量: 124
- PDF下载量: 15
- 被引次数: 0
出版历程
- 收稿日期: 2024-10-15
- 录用日期: 2024-11-29
- 出版日期: 2025-06-25

Efficacy of robot-assisted versus laparoscopic parenchymal-sparing pancreatectomy in treatment of pancreatic neuroendocrine neoplasm

Department of General Surgery，Peking Union Medical College Hospital，Peking Union Medical College，Chinese Academy of Medical Sciences，Beijing 100730，China

Research funding:

National Natural Science Foundation of China (82272917);

National High Level Hospital Clinical Research Funding (2022-PUMCH-B-004)

More Information

Corresponding author: ZHANG Taiping， tpingzhang@yahoo.com （ORCID： 0000-0003-1689-6908）

摘要

摘要: 目的对比分析机器人辅助胰腺实质保留手术（R-PSP）与腹腔镜胰腺实质保留手术（L-PSP）在胰腺神经内分泌肿瘤（pNEN）中的临床应用情况，评估R-PSP术式的安全性和有效性。方法回顾性分析2017年12月—2023年8月于中国医学科学院北京协和医学院北京协和医院基本外科行胰腺实质保留手术的pNEN患者临床资料，根据微创术式的不同，将纳入患者分为R-PSP组和L-PSP组。从微创效果、术后并发症结局及肿瘤学疗效3个方面分析R-PSP与L-PSP的差异。计量资料两组间比较采用成组t检验或Mann-Whitney U检验。计数资料两组间比较采用χ²检验或Fisher精确检验。等级资料两组间比较采用Mann-Whitney U检验。结果共纳入pNEN患者45例，其中R-PSP组9例，L-PSP组36例，两组患者基线资料比较，差异均无统计学意义（P值均>0.05）。两组间在手术时间、术中出血量、术中输血、中转开腹率方面未见明显差异（P值均>0.05）。与L-PSP组相比，R-PSP组术后住院时间显著延长［10.00（9.00～15.00） d vs 7.50（6.00～10.00） d，Z=-2.356，P=0.017］，住院费用更高［86 610.44（81 905.39～114 401.24）元 vs 38 781.20（31 708.39～50 514.76）元，Z=-4.001，P<0.001］。两组在术后严重并发症（Clavien-Dindo分级≥Ⅲ级）、临床相关胰腺术后胰瘘、胃延迟排空、腹腔感染等术后并发症发生率方面差异均无统计学意义（P值均>0.05）。两组间术后90 d病死率均为0。结论 R-PSP在pNEN患者临床应用的安全性和有效性方面表现尚可。
- 胰腺神经内分泌肿瘤 /
- 机器人手术 /
- 腹腔镜检查 /
- 治疗结果
Abstract: Objective To compare and analyze the clinical application of robot-assisted parenchymal-sparing pancreatectomy （R-PSP） and laparoscopic parenchymal-sparing pancreatectomy （L-PSP） in the treatment of pancreatic neuroendocrine neoplasm （pNEN）， and to evaluate the safety and efficacy of the R-PSP procedure. Methods A retrospective analysis was performed for the clinical data of pNEN patients who underwent parenchymal-sparing pancreatectomy in Department of General Surgery， Peking Union Medical College Hospital， Peking Union Medical College， Chinese Academy of Medical Sciences， from December 2017 to August 2023， and according to the minimally invasive surgical procedure， they were divided into R-PSP group and L-PSP group. R-PSP and L-PSP were compared in terms of the efficacy of minimally invasive procedure， the outcome of postoperative complications， and oncological efficacy. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups； the Mann-Whitney U test was used for comparison of ranked data between two groups. Results A total of 45 pNEN patients were included， with 9 in the R-PSP group and 36 in the L-PSP group， and there were no significant differences in baseline data between the two groups （all P>0.05）. There were no significant differences between the two groups in time of operation， intraoperative blood loss， intraoperative blood transfusion， and the rate of conversion to laparotomy （all P>0.05）. Compared with the L-PSP group， the R-PSP group had a significantly longer length of postoperative hospital stay ［10.00 （9.00‍ ‍—‍ ‍15.00） days vs 7.50 （6.00‍ ‍—‍ ‍10.00） days， Z=-2.356， P=0.017］ and significantly higher hospital costs ［86 610.44 （81 905.39‍ ‍—‍ ‍114 401.24） yuan vs 38 781.20 （31 708.39‍ ‍—‍ ‍50 514.76） yuan， Z=-4.001， P<0.001］. There were no significant differences between the two groups in the incidence rates of serious postoperative complications （Clavien-Dindo grade ≥Ⅲ）， clinically relevant pancreatic fistula， delayed gastric emptying， and intra-abdominal infection （all P>0.05）. The postoperative 90-day mortality rate was 0% for both groups. Conclusion R-PSP has acceptable safety and efficacy in pNEN patients in clinical practice.
- Pancreatic Neuroendocrine Neoplasm /
- Robotic Surgical Procedures /
- Laparoscopy /
- Treatment Outcome

HTML全文

表 1 两组患者临床及病理资料比较

Table 1. Clinical and histopathological data between the two groups of patients

指标	L-PSP组（n=36）	R-PSP组（n=9）	统计值	P值
年龄（岁）	51.58±13.11	45.44±17.13	t=1.181	0.244
男［例（%）］	15（41.67）	7（77.78）	χ²=3.757	0.053
BMI（kg/m²）	26.84±3.52	26.21±2.32	t=0.507	0.615
ASA分级［例（%）］			Z=-1.485	0.137
Ⅰ级	3（8.33）	2（22.22）
Ⅱ级	29（80.56）	7（77.78）
Ⅲ级	4（11.11）	0（0.00）
Charlson合并症指数［例（%）］			Z=-0.184	0.854
0～2分	29（80.56）	7（77.78）
>2分	7（19.44）	2（22.22）
吸烟史［例（%）］	5（13.89）	3（33.33）	χ²=1.862	0.326
既往手术史［例（%）］	14（38.89）	6（66.67）	χ²=2.250	0.134
肿瘤直径（cm）	1.50（1.20～2.00）	1.20（1.20～2.00）	Z=-0.317	0.770
病理分级［例（%）］			Z=-0.211	0.833
G1	18（50.00）	4（44.44）
G2	17（47.22）	5（55.56）
未明确	1（2.78）	0（0.00）
肿瘤部位［例（%）］			χ²=1.513	0.219
胰头/颈	24（66.67）	4（44.44）
胰体/尾	12（33.33）	5（55.56）
胰管扩张［例（%）］	2（5.56）	0（0.00）		>0.05

下载: 导出CSV

表 2 两组患者微创效果比较

Table 2. Comparison of minimally invasive effects between the two groups of patients

指标	L-PSP组（n=36）	R-PSP组（n=9）	Z值	P值
手术时间（min）	124.50（86.25～155.00）	122.00（104.50～198.50）	-0.993	0.334
术中出血量（mL）	50.00（50.00～50.00）	50.00（50.00～100.00）	-0.762	0.548
术后住院时间（d）	7.50（6.00～10.00）	10.00（9.00～15.00）	-2.356	0.017
住院费用（元）	38 781.20（31 708.39～50 514.76）	86 610.44（81 905.39～114 401.24）	-4.001	<0.001

下载: 导出CSV

参考文献(24)

[1]	KORREL M, van HILST J, BOSSCHA K, et al. Nationwide use and outcome of minimally invasive distal pancreatectomy in IDEAL stage IV following a training program and randomized trial[J]. Ann Surg, 2024, 279( 2): 323- 330. DOI: 10.1097/SLA.0000000000005900.
[2]	BERARDI G, LUCARINI A, COLASANTI M, et al. Minimally invasive surgery for perihilar cholangiocarcinoma: A systematic review of the short- and long-term results[J]. Cancers(Basel), 2023, 15( 11): 3048. DOI: 10.3390/cancers15113048.
[3]	SHAH MH, GOLDNER WS, BENSON AB, et al. Neuroendocrine and adrenal tumors, version 2.2021, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19( 7): 839- 868. DOI: 10.6004/jnccn.2021.0032.
[4]	Society of Neuroendocrine Neoplasm of China Anti-Cancer Association. China Anti-Cancer Association guideline for diagnosis and treatment of neuroendocrine neoplasm(2022 edition)[J]. China Oncol, 2022, 32( 6): 545- 580. DOI: 10.19401/j.cnki.1007-3639.2022.06.010. 中国抗癌协会神经内分泌肿瘤专业委员会. 中国抗癌协会神经内分泌肿瘤诊治指南(2022年版)[J]. 中国癌症杂志, 2022, 32( 6): 545- 580. DOI: 10.19401/j.cnki.1007-3639.2022.06.010.
[5]	Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association, Pancreatic Disease Committee of China Research Hospital Association, Editorial Board of Chinese Journal of Surgery. The guideline for prevention and treatment of common complications after pancreatic surgery(2022)[J]. Chin J Surg, 2023, 61( 7): 529- 534. DOI: 10.3760/cma.j.cn112139-20230419-00173. 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺疾病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症防治指南(2022)[J]. 中华外科杂志, 2023, 61( 7): 529- 534. DOI: 10.3760/cma.j.cn112139-20230419-00173.
[6]	WANG XZ, WU WM. Evolution in the surgical treatment concepts of pancreatic neuroendocrine tumors[J]. China Oncol, 2022, 32( 9): 765- 771. DOI: 10.19401/j.cnki.1007-3639.2022.09.002. 王先泽, 吴文铭. 胰腺神经内分泌肿瘤外科治疗理念的四种转变[J]. 中国癌症杂志, 2022, 32( 9): 765- 771. DOI: 10.19401/j.cnki.1007-3639.2022.09.002.
[7]	XU ZH, WANG L, DAI S, et al. Epidemiologic trends of and factors associated with overall survival for patients with gastroenteropancreatic neuroendocrine tumors in the United States[J]. JAMA Netw Open, 2021, 4( 9): e2124750. DOI: 10.1001/jamanetworkopen.2021.24750.
[8]	LOU X, QIN Y, XU XW, et al. Spatiotemporal heterogeneity and clinical challenge of pancreatic neuroendocrine tumors[J]. Biochim Biophys Acta Rev Cancer, 2022, 1877( 5): 188782. DOI: 10.1016/j.bbcan.2022.188782.
[9]	de PONTHAUD C, MENEGAUX F, GAUJOUX S. Updated principles of surgical management of pancreatic neuroendocrine tumours(pNETs): What every surgeon needs to know[J]. Cancers(Basel), 2021, 13( 23): 5969. DOI: 10.3390/cancers13235969.
[10]	YANG JN, ZHANG HR. Research advances in the mechanism of tumor microenvironment and targeted therapy for pancreatic neuroen docrine tumor[J]. J Clin Hepatol, 2023, 39( 8): 2005- 2011. DOI: 10.3969/j.issn.1001-5256.2023.08.036. 杨佳妮, 张海蓉. 胰腺神经内分泌肿瘤微环境的形成机制及免疫/靶向治疗研究进展[J]. 临床肝胆病杂志, 2023, 39( 8): 2005- 2011. DOI: 10.3969/j.issn.1001-5256.2023.08.036.
[11]	DENG XW, SHAO CH. Progress in transformation therapy for pancreatic neuroendocrine neoplasms[J/OL]. Chin J Hepat Surg(Electronic Edition), 2024, 13( 4): 456- 460. DOI: 10.3877/cma.j.issn.2095-3232.2024.04.003. 邓小巍, 邵成浩. 胰腺神经内分泌肿瘤转化治疗进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13( 4): 456- 460. DOI: 10.3877/cma.j.issn.2095-3232.2024.04.003.
[12]	GIULIANI T, de PASTENA M, PAIELLA S, et al. Pancreatic enucleation patients share the same quality of life as the general population at long-term follow-up: A propensity score-matched analysis[J]. Ann Surg, 2023, 277( 3): e609- e616. DOI: 10.1097/SLA.0000000000004911.
[13]	BOLM L, NEBBIA M, WEI AC, et al. Long-term outcomes of parenchyma-sparing and oncologic resections in patients with nonfunctional pancreatic neuroendocrine tumors<3 cm in a large multicenter cohort[J]. Ann Surg, 2022, 276( 3): 522- 531. DOI: 10.1097/SLA.0000000000005559.
[14]	LIN XC, LIN RG, LU FC, et al. Application value of robot-assisted parenchyma-sparing pancreatectomy[J]. Chin J Dig Surg, 2024, 23( 5): 733- 738. DOI: 10.3760/cma.j.cn115610-20240321-00174. 林贤超, 林荣贵, 陆逢春, 等. 机器人辅助保留胰腺实质切除术的应用价值[J]. 中华消化外科杂志, 2024, 23( 5): 733- 738. DOI: 10.3760/cma.j.cn115610-20240321-00174.
[15]	GIULIANOTTI PC, CORATTI A, ANGELINI M, et al. Robotics in general surgery: Personal experience in a large community hospital[J]. Arch Surg, 2003, 138( 7): 777- 784. DOI: 10.1001/archsurg.138.7.777.
[16]	GIULIANOTTI PC, SBRANA F, BIANCO FM, et al. Robot-assisted laparoscopic middle pancreatectomy[J]. J Laparoendosc Adv Surg Tech A, 2010, 20( 2): 135- 139. DOI: 10.1089/lap.2009.0296.
[17]	KU G, KANG I, LEE WJ, et al. Revo-i assisted robotic central pancreatectomy[J]. Ann Hepatobiliary Pancreat Surg, 2020, 24( 4): 547- 550. DOI: 10.14701/ahbps.2020.24.4.547.
[18]	ZWART MJW, NOTA CLM, de ROOIJ T, et al. Outcomes of a multicenter training program in robotic pancreatoduodenectomy(LAELAPS-3)[J]. Ann Surg, 2022, 276( 6): e886- e895. DOI: 10.1097/SLA.0000000000004783.
[19]	FAN SB, HAO H, CHEN SL, et al. Robot-assisted laparoscopic radical prostatectomy using the KangDuo surgical robot system vs the da Vinci Si robotic system[J]. J Endourol, 2023, 37( 5): 568- 574. DOI: 10.1089/end.2022.0739.
[20]	LI XS, XU WF, FAN SB, et al. Robot-assisted partial nephrectomy with the newly developed KangDuo surgical robot versus the da Vinci Si surgical system: A double-center prospective randomized controlled noninferiority trial[J]. Eur Urol Focus, 2023, 9( 1): 133- 140. DOI: 10.1016/j.euf.2022.07.008.
[21]	MÜLLER PC, BREUER E, NICKEL F, et al. Robotic distal pancreatectomy: A novel standard of care? Benchmark values for surgical outcomes from 16 international expert centers[J]. Ann Surg, 2023, 278( 2): 253- 259. DOI: 10.1097/SLA.0000000000005601.
[22]	UIJTERWIJK BA, LEMMERS DHL, BOLM L, et al. Long-term outcomes after laparoscopic, robotic, and open pancreatoduodenectomy for distal cholangiocarcinoma: An international propensity score-matched cohort study[J]. Ann Surg, 2023, 278( 3): e570- e579. DOI: 10.1097/SLA.0000000000005743.
[23]	LIU Q, ZHAO ZM, ZHANG XP, et al. Perioperative and oncological outcomes of robotic versus open pancreaticoduodenectomy in low-risk surgical candidates: A multicenter propensity score-matched study[J]. Ann Surg, 2023, 277( 4): e864- e871. DOI: 10.1097/SLA.0000000000005160.
[24]	ZHENG R, GHABI E, HE J. Robotic parenchymal-sparing pancreatectomy: A systematic review[J]. Cancers(Basel), 2023, 15( 17): 4369. DOI: 10.3390/cancers15174369.