机器人与腹腔镜微创手术治疗分化良好的胰腺神经内分泌瘤的临床研究

doi:10.19401/j.cnki.1007-3639.2022.09.005

中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (9): 786-793.doi: 10.19401/j.cnki.1007-3639.2022.09.005

机器人与腹腔镜微创手术治疗分化良好的胰腺神经内分泌瘤的临床研究

刘文生¹(), 吉顺荣¹, 卓奇峰¹, 高鹤丽¹, 史逸华¹, 许文彦¹, 刘梦奇¹, 李征¹, 虞先濬¹, 陈洁², 徐晓武¹()

1.复旦大学附属肿瘤医院胰腺外科,复旦大学上海医学院肿瘤学系,复旦大学胰腺肿瘤研究所,上海市胰腺肿瘤研究所,上海 200032
2.复旦大学附属肿瘤医院神经内分泌肿瘤中心,头颈及神经内分泌肿瘤内科,复旦大学上海医学院肿瘤学系,上海 200032

收稿日期:2022-08-12 修回日期:2022-09-10 出版日期:2022-09-30 发布日期:2022-10-24
通信作者: 徐晓武
作者简介:刘文生（ORCID: 0000-0002-2177-326X）,博士,主治医师。
徐晓武,复旦大学附属肿瘤医院胰腺外科副主任,胰腺微创手术中心主任,肿瘤外科微创手术平台副主任。师从国内著名微创外科专家牟一平教授,在国内率先开展各类腹腔镜微创胰腺和胃肠手术。中国医师协会外科医师分会微创外科医师委员会青年委员,中国抗癌协会胰腺癌专业委员会常务委员,上海市医学会普外科专科分会青年委员,上海市医学会普外科专科分会微创学组委员,上海市抗癌协会胰腺癌专业委员会多区域诊疗协作青年学组副组长,上海市抗癌协会胰腺癌专业委员会委员。擅长各类胰腺的机器人及腹腔镜微创手术,每年率领团队完成各类胰腺手术500余例,其中微创比例超过80%。同时开展了大量保留功能的胰腺微创手术,包括保脾胰体尾切除、胰腺中段切除、胰腺肿瘤剜除、保留十二指肠的胰头切除等。多次完成腹腔镜胰十二指肠切除术的会议及网络直播,具有丰富的临床诊疗经验。除开展临床诊治工作及临床研究外,同时带领研究小组致力开展与胰腺恶性肿瘤相关的基础转化研究。研究的主要方向围绕驱动基因在胰腺癌发生、发展中的作用以及代谢异常在胰腺癌中的作用,近5年在Cancer Research、Oncogene、Cancer Letters、Cell Proliferation等杂志发表了多篇原创研究论文,探寻调控胰腺癌恶性潜能的分子机制,为逆转胰腺癌发生、发展、侵袭及转移等恶性潜能提供预测和干预靶点,改善患者预后。作为项目负责人主持国家自然科学基金项目2项、主持省部级科研项目4项,作为第一作者或通信作者在SCI收录期刊上发表论文20篇。作为主要完成人（排名第二）获浙江省科技进步二等奖一项。

Clinical study of robot and laparoscopic minimally invasive surgery for well-differentiated pancreatic neuroendocrine tumors

LIU Wensheng¹(), JI Shunrong¹, ZHUO Qifeng¹, GAO Heli¹, SHI Yihua¹, XU Wenyan¹, LIU Mengqi¹, LI Zheng¹, YU Xianjun¹, CHEN Jie², XU Xiaowu¹()

1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Pancreatic Cancer Institute, Fudan University, Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
2. Center for Neuroendocrine Tumors, Department of Head, Neck and Neuroendocrine Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

Received:2022-08-12 Revised:2022-09-10 Published:2022-09-30 Online:2022-10-24
Contact: XU Xiaowu

摘要/Abstract

摘要：

背景与目的： 胰腺神经内分泌瘤（pancreatic neuroendocrine tumor,pNET）为少见肿瘤,目前仍缺乏总结微创手术治疗pNET的临床效果的大样本临床研究数据,本研究通过分析接受手术治疗的pNET患者的临床资料,以期为pNET的外科治疗提供参考。方法： 回顾性分析2018年9月—2022年7月于复旦大学附属肿瘤医院胰腺外科行微创手术的118例分化良好的pNET患者的临床资料。根据微创手术方式分为机器人组和腹腔镜组,根据手术切除方式分为规则切除组和局部切除组。收集其手术及术后相关临床资料进行分析。结果： 本研究纳入的118例pNET患者中,机器人组17例,腹腔镜组101例。局部切除组32例,规则切除组86例。机器人组和腹腔镜组在手术时间、术中出血量方面无显著差异（P>0.05）。局部切除组的手术时间[（145.3±55.5）min]明显短于规则切除组[（247.4±94.7）min]（P<0.05）。同时,局部切除组的术中出血量[（71.8±23.2）mL]明显少于规则切除组[（147.5±59.9）mL]（P<0.05）。机器人组的术后胃肠功能恢复早于腹腔镜组（P<0.05）,两组在术后下床活动时间、术后胰瘘、胃排空延迟、术区积液及术后住院时间等方面均无显著差异（P>0.05）。局部切除组的术后B级胰瘘发生率高于规则切除组（P<0.05）,局部切除组的术后住院时间要明显长于规则切除组（P<0.05）。结论： 微创手术治疗分化良好的pNET安全、可行。腹腔镜和机器人在微创手术疗效方面无显著差异。肿瘤局部切除因术后胰瘘发生率增高,术后住院时间较长,但其远期获益可期。

关键词: 胰腺神经内分泌瘤, 微创手术, 机器人手术, 肿瘤局部切除手术, 功能保留手术

Abstract:

Background and purpose: Pancreatic neuroendocrine tumor (pNET) is a rare tumor. At present, there is still a lack of large-scale clinical research data to summarize the clinical effect of minimally invasive technology in the treatment of pNET. This study analyzed the clinical data of pNET patients undergoing surgical treatment, in order to provide reference for the surgical treatment of pNET. Methods: The clinical data of 118 patients with well-differentiated pNET undergoing minimally invasive surgery admitted by the Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center from September 2018 to July 2022 were retrospectively analyzed. The patients were divided into robot group (n=17) and laparoscopic group (n=101) according to the minimally invasive operation mode. According to the surgical resection mode, they were divided into regular resection group (n=86) and local resection group (n=32). The clinical data of operation and postoperation were collected and analyzed. Results: Of the 118 patients who underwent minimally invasive surgery on pNET included in this study, 17 were in the robot group, and 101 were in the laparoscopic group. There were 32 cases in local resection group and 86 cases in regular resection group. There was no significant difference between robot group and laparoscopic group in operation time and intraoperative bleeding (P>0.05). The operation time of local resection group [(145.3±55.5) min] was significantly shorter compared with regular resection group [(247.4±94.7) min](P <0.05). At the same time, the bleeding volume [(71.8±23.2) mL] was significantly less in the local resection group than in the regular resection group [(147.5±59.9) mL](P<0.05). The recovery of gastrointestinal function in the robot group was earlier compared with laparoscopic group (P<0.05). There was no significant difference between the two groups in terms of postoperative ambulatory time, postoperative pancreatic fistula, delayed gastric emptying, postoperative effusion and postoperative hospitalization time (P>0.05). The incidence of postoperative b-pancreatic fistula was higher in the local resection group than in the regular resection group (P<0.05), and the postoperative hospital stay was significantly longer in the local resection group than in the regular resection group (P<0.05). Conclusion: Minimally invasive surgery is safe and feasible to treat well-differentiated pNET. There was no significant difference in minimally invasive effect between laparoscope and robot. The incidence of pancreatic fistula after local resection of tumor is higher, and the postoperative hospital stay is longer, however the long-term benefit is expected.

Key words: Pancreatic neuroendocrine tumor, Minimally invasive surgery, Robotic surgery, Local excision of tumor, Function-preserving operation

中图分类号:

R735.9

刘文生, 吉顺荣, 卓奇峰, 高鹤丽, 史逸华, 许文彦, 刘梦奇, 李征, 虞先濬, 陈洁, 徐晓武. 机器人与腹腔镜微创手术治疗分化良好的胰腺神经内分泌瘤的临床研究[J]. 中国癌症杂志, 2022, 32(9): 786-793.

LIU Wensheng, JI Shunrong, ZHUO Qifeng, GAO Heli, SHI Yihua, XU Wenyan, LIU Mengqi, LI Zheng, YU Xianjun, CHEN Jie, XU Xiaowu. Clinical study of robot and laparoscopic minimally invasive surgery for well-differentiated pancreatic neuroendocrine tumors[J]. China Oncology, 2022, 32(9): 786-793.

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Characteristic	Minimally invasive surgery		χ²/t value	P value	Surgical resection mode		χ²/t value	P value
Characteristic	Robot (n = 17)	Laparoscopic (n = 101)	χ²/t value	P value	Local resection (n = 32)	Regular resection (n = 86)	χ²/t value	P value
Gender			2.448	0.118			2.433	0.119
Male	10 (58.8)	39 (38.6)			17 (53.1)	32 (37.2)
Female	7 (41.2)	62 (61.4)			15 (46.9)	54 (62.8)
Tumor location			3.500	0.321			18.202	0.000 4
Pancreatic head and unciform process	8 (47.1)	32 (31.7)			18 (56.3)	22 (25.6)
Pancreatic neck	4 (23.5)	15 (14.9)			5 (15.6)	14 (16.3)
Pancreatic body and tail	5 (29.4)	52 (51.5)			7 (21.9)	50 (58.1)
Multiple lesions of pancreas	0 (0.0)	2 (19.8)			2 (6.3)	0 (0.0)
Maximum diameter of tumor/cm $\bar{x}\pm s$	3.04±2.58	3.66±2.34	0.996	0.321	1.58±1.47	3.45±2.62	3.814	<0.001
Histological grade			1.120	0.571			1.241	0.538
G1	6 (35.3)	48 (47.5)			17 (53.1)	37 (43.0)
G2	11 (64.5)	52 (51.5)			15 (46.9)	48 (55.8)
G3	0 (0.0)	1 (1.0)			0 (0.0)	1 (1.0)
Pathologically heterogeneous cases	0 (0.0)	1 (1.0)	1.036	0.309	1 (1.0)	0 (0.0)	0.267	0.605
Positive lymph node	3 (17.6)	6 (5.9)	1.413	0.235	0 (0.0)	9 (10.5)	2.292	0.130

Indicator of intraoperative condition	Minimally invasive surgery		t value	P value	Surgical resection mode		t value	P value
Indicator of intraoperative condition	Robot (n=17)	Laparoscopic (n=101)	t value	P value	Local resection (n=32)	Regular resection (n=86)	t value	P value
Operation time/min	190.2±84.1	185.6±62.4	0.267	0.790	145.3±55.5	247.4±94.7	5.734	<0.001
Intraoperative blood loss/mL	81.7±50.2	111.2±71.6	1.630	0.106	71.8±23.2	147.5±59.9	6.942	<0.001

Postoperative outcomes index	Minimally invasive surgery		χ²/t value	P value	Surgical resection mode		χ²/t value	P value
Postoperative outcomes index	Robot (n = 17)	Laparoscopic (n = 101)	χ²/t value	P value	Local resection (n = 32)	Regular resection (n = 86)	χ²/t value	P value
postoperative activity time $\bar{x}\pm s$	2.1±0.3	2.2±0.5	0.799	0.426	2.1±0.4	2.1±0.5	0	1.000
First exhaust time $\bar{x}\pm s$	1.8±0.5	2.2±0.4	3.675	0.000	1.5±0.7	2.3±0.4	7.755	<0.001
Time to resume liquid diet $\bar{x}\pm s$	3.0±0.6	3.6±0.5	4.445	0.000	3.1±0.9	3.6±1.0	2.478	0.015
Pancreatic fistula			3.701	0.296			8.486	0.037
Without n (%)	5 (29.4)	24 (23.8)			8 (25.0)	26 (30.2)
Biochemical leakage n (%)	8 (47.1)	29 (28.7)			8 (25.0)	39 (45.3)
Grade B n (%)	4 (23.5)	47 (46.5)			16 (50.0)	20 (23.3)
Grade C n (%)	0(0.0)	1 (1.0)			0(0.0)	1 (1.2)
Delayed gastric emptying n (%)	1 (5.9)	2 (2.0)	0.013	0.910	2 (6.3)	1 (1.2)	0.815	0.367
Puncture drainage of peritoneal effusion n (%)	1 (5.9)	2 (2.0)	0.013	0.910	2 (6.3)	1 (1.2)	0.815	0.367
Postoperative hospital stay/d $\bar{x}\pm s$	9.9±4.2	10.8±6.4	0.559	0.577	12.1±5.6	9.1±4.9	2.843	0.005
Readmission n (%)	0(0.0)	3 (3.0)	0.013	0.910	2 (6.3)	1 (1.2)	0.815	0.367

机器人与腹腔镜微创手术治疗分化良好的胰腺神经内分泌瘤的临床研究

Clinical study of robot and laparoscopic minimally invasive surgery for well-differentiated pancreatic neuroendocrine tumors

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