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

Wensheng LIU; Shunrong JI; Qifeng ZHUO; Heli GAO; Yihua SHI; Wenyan XU; Mengqi LIU; Zheng LI; Xianjun YU; Jie CHEN; Xiaowu XU

doi:10.19401/j.cnki.1007-3639.2022.09.005

您当前的位置：

首页 >

文章列表页 >

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

Specialists' Article | 更新时间：2025-12-31

- Clinical study of robot and laparoscopic minimally invasive surgery for well-differentiated pancreatic neuroendocrine tumors
- China Oncology Vol. 32, Issue 9, Pages: 786-793(2022)
- 作者机构：
  
  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
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.09.005
  CLC： R735.9
- Received：12 August 2022，
  
  Revised：2022-09-10，
  
  Published：30 September 2022
- 稿件说明：
移动端阅览
Wensheng LIU, Shunrong JI, Qifeng ZHUO, et al. Clinical study of robot and laparoscopic minimally invasive surgery for well-differentiated pancreatic neuroendocrine tumors[J]. China Oncology, 2022, 32(9): 786-793.
DOI：

Wensheng LIU, Shunrong JI, Qifeng ZHUO, et al. Clinical study of robot and laparoscopic minimally invasive surgery for well-differentiated pancreatic neuroendocrine tumors[J]. China Oncology, 2022, 32(9): 786-793. DOI： 10.19401/j.cnki.1007-3639.2022.09.005.

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

#x02014;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（

0.05）。局部切除组的手术时间[（145.3

#x000b1;55.5）min

]

明显短于规则切除组[（247.4

#x000b1;94.7）min

]

（

0.05）。同时

局部切除组的术中出血量[（71.8

#x000b1;23.2）mL

]

明显少于规则切除组[（147.5

#x000b1;59.9）mL

]

（

0.05）。机器人组的术后胃肠功能恢复早于腹腔镜组（

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（

0.05）。局部切除组的术后B级胰瘘发生率高于规则切除组（

0.05）

局部切除组的术后住院时间要明显长于规则切除组（

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。

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 (

=17) and laparoscopic group (

=101) according to the minimally invasive operation mode. According to the surgical resection mode

they were divided into regular resection group (

=86) and local resection group (

=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 (

0.05). The operation time of local resection group [(145.3

#x000b1;55.5) min

]

was significantly shorter compared with regular resection group [(247.4

#x000b1;94.7) min

]

(

0.05). At the same time

the bleeding volume [(71.8

#x000b1;23.2) mL

]

was significantly less in the local resection group than in the regular resection group [(147.5

#x000b1;59.9) mL

]

(

0.05). The recovery of gastrointestinal function in the robot

group was earlier compared with laparoscopic group (

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 (

0.05). The incidence of postoperative b-pancreatic fistula was higher in the local resection group than in the regular resection group (

0.05)

and the postoperative hospital stay was significantly longer in the local resection group than in the regular resection group (

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.

关键词

Keywords

references

DASARI A , SHEN C , HALPERIN D , et al . Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States [J ] . JAMA Oncol , 2017 , 3 ( 10 ): 1335 - 1342 . DOI: 10.1001/jamaoncol.2017.0589 http://doi.org/10.1001/jamaoncol.2017.0589

FAN J H , ZHANG Y Q , SHI S S , et al . A nation-wide retrospective epidemiological study of gastroenteropancreatic neuroendocrine neoplasms in China [J ] . Oncotarget , 2017 , 8 ( 42 ): 71699 - 71708 . DOI: 10.18632/oncotarget.17599 http://doi.org/10.18632/oncotarget.17599 https://www.oncotarget.com/lookup/doi/10.18632/oncotarget.17599 https://www.oncotarget.com/lookup/doi/10.18632/oncotarget.17599

ITO T , IGARASHI H , NAKAMURA K , et al . Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis [J ] . J Gastroenterol , 2015 , 50 ( 1 ): 58 - 64 . DOI: 10.1007/s00535-014-0934-2 http://doi.org/10.1007/s00535-014-0934-2

NAGTEGAAL I D , ODZE R D , KLIMSTRA D , et al . The 2019 WHO classification of tumours of the digestive system [J ] . Histopathology , 2020 , 76 ( 2 ): 182 - 188 . DOI: 10.1111/his.13975 http://doi.org/10.1111/his.13975

刘文生 , 许文彦 , 吉顺荣 , 等 . 腹腔镜胰体尾切除治疗神经内分泌肿瘤单中心研究 [J ] . 腹腔镜外科杂志 , 2019 , 24 ( 10 ): 766 - 769 .

LIU W S , XU W Y , JI S R , et al . A single institution study of laparoscopic pancreatectomy for pancreatic neuroendocrine tumor in body and tail of pancreas [J ] . J Laparosc Surg , 2019 , 24 ( 10 ): 766 - 769 .

王于 , 陈洁 . 胰腺神经内分泌肿瘤复杂肝转移的介入及药物治疗策略 [J ] . 协和医学杂志 , 2020 , 11 ( 4 ): 389 - 394 .

WANG Y , CHEN J . The management strategies of interventional therapy and drug therapy of complicated pancreatic neuroendocrine neoplasms with liver metastases [J ] . Med J Peking Union Med Coll Hosp , 2020 , 11 ( 4 ): 389 - 394 .

DINDO D , DEMARTINES N , CLAVIEN P A . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey [J ] . Ann Surg , 2004 , 240 ( 2 ): 205 - 213 . DOI: 10.1097/01.sla.0000133083.54934.ae http://doi.org/10.1097/01.sla.0000133083.54934.ae

BASSI C , MARCHEGIANI G , DERVENIS C , et al . The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after [J ] . Surgery , 2017 , 161 ( 3 ): 584 - 591 . DOI: 10.1016/j.surg.2016.11.014 http://doi.org/10.1016/j.surg.2016.11.014 https://linkinghub.elsevier.com/retrieve/pii/S0039606016307577 https://linkinghub.elsevier.com/retrieve/pii/S0039606016307577

THOMASCHEWSKI M , NEEFF H , KECK T , et al . Is there any role for minimally invasive surgery in NET? [J ] . Rev Endocr Metab Disord , 2017 , 18 ( 4 ): 443 - 457 . DOI: 10.1007/s11154-017-9436-x http://doi.org/10.1007/s11154-017-9436-x http://link.springer.com/10.1007/s11154-017-9436-x http://link.springer.com/10.1007/s11154-017-9436-x

VAN NIEUWENHOVE Y , DELVAUX G . Laparoscopic management of neuroendocrine tumours of the pancreas [J ] . Acta Chir Belg , 1999 , 99 ( 5 ): 249 - 252 .

MELVIN W S , NEEDLEMAN B J , KRAUSE K R , et al . Computer-enhanced robotic telesurgery. Initial experience in foregut surgery [J ] . Surg Endosc , 2002 , 16 ( 12 ): 1790 - 1792 .

ZIOGAS I A , SCHMITZ R , MORIS D , et al . The role of surgery for pancreatic neuroendocrine tumors [J ] . Anticancer Res , 2022 , 42 ( 2 ): 629 - 639 . DOI: 10.21873/anticanres.15520 http://doi.org/10.21873/anticanres.15520

HAN S H , HAN I W , HEO J S , et al . Laparoscopic versus open distal pancreatectomy for nonfunctioning pancreatic neuroendocrine tumors: a large single-center study [J ] . Surg Endosc , 2018 , 32 ( 1 ): 443 - 449 . DOI: 10.1007/s00464-017-5702-y http://doi.org/10.1007/s00464-017-5702-y

DRYMOUSIS P , RAPTIS D A , SPALDING D , et al . Laparoscopic versus open pancreas resection for pancreatic neuroendocrine tumours: a systematic review and meta-analysis [J ] . HPB (Oxford) , 2014 , 16 ( 5 ): 397 - 406 . DOI: 10.1111/hpb.12162 http://doi.org/10.1111/hpb.12162 https://linkinghub.elsevier.com/retrieve/pii/S1365182X1531580X https://linkinghub.elsevier.com/retrieve/pii/S1365182X1531580X

TAN H L , TEO R Y A , SYN N L , et al . Minimally invasive versus open pancreatectomies for pancreatic neuroendocrine neoplasms: a propensity-score-matched study [J ] . World J Surg , 2020 , 44 ( 9 ): 3043 - 3051 . DOI: 10.1007/s00268-020-05582-3 http://doi.org/10.1007/s00268-020-05582-3 https://doi.org/10.1007/s00268-020-05582-3 https://doi.org/10.1007/s00268-020-05582-3

HAUGVIK S P , MARANGOS I P , RØSOK B I , et al . Long-term outcome of laparoscopic surgery for pancreatic neuroendocrine tumors [J ] . World J Surg , 2013 , 37 ( 3 ): 582 - 590 . DOI: 10.1007/s00268-012-1893-5 http://doi.org/10.1007/s00268-012-1893-5 http://link.springer.com/10.1007/s00268-012-1893-5 http://link.springer.com/10.1007/s00268-012-1893-5

CABA MOLINA D , LAMBRETON F , ARRANGOIZ MAJUL R . Trends in robotic pancreaticoduodenectomy and distal pancreatectomy [J ] . J Laparoendosc Adv Surg Tech A , 2019 , 29 ( 2 ): 147 - 151 . DOI: 10.1089/lap.2018.0421 http://doi.org/10.1089/lap.2018.0421

赵之明 , 尹注增 , 姜楠 , 等 . 机器人与腹腔镜肿瘤剜除术治疗胰头部胰岛素瘤的对比研究 [J ] . 腹腔镜外科杂志 , 2020 , 25 ( 4 ): 241 - 244 .

ZHAO Z M , YIN Z Z , JIANG N , et al . A comparative study of robotic and laparoscopic tumor enucleation in the treatment of pancreatic head insulinoma [J ] . J Laparosc Surg , 2020 , 25 ( 4 ): 241 - 244 .

ZHANG J Q , JIN J B , CHEN S , et al . Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach ?[J ] . Oncotarget , 2017 , 8 ( 20 ): 33872 - 33883 . DOI: 10.18632/oncotarget.17513 http://doi.org/10.18632/oncotarget.17513

周雨 , 陈洛海 , 李德智 , 等 . 小非功能性胰腺神经内分泌肿瘤的预后因素 [J ] . 中华消化杂志 , 2018 ( 3 ): 187 - 191 .

ZHOU Y , CHEN L H , LI D Z , et al . Prognostic factors of small non-functional pancreatic neuroendocrine tumors [J ] . Chin J Dig , 2018 ( 3 ): 187 - 191 .

姜佳霖 , 吴文铭 , 赵玉沛 . 微小胰腺神经内分泌肿瘤的诊疗进展 [J ] . 中华外科杂志 , 2018 ( 12 ): 951 - 956 .

JIANG J L , WU W M , ZHAO Y P . Current diagnosis and treatment progress of small pancreatic neuroendocrine neoplasm [J ] . Chin J Surg , 2018 ( 12 ): 951 - 956 .

FALCONI M , ERIKSSON B , KALTSAS G , et al . ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors [J ] . Neuroendocrinology , 2016 , 103 ( 2 ): 153 - 171 . DOI: 10.1159/000443171 http://doi.org/10.1159/000443171

SHAH M H , GOLDNER W S , BENSON A B , 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 http://doi.org/10.6004/jnccn.2021.0032 https://jnccn.org/view/journals/jnccn/19/7/article-p839.xml https://jnccn.org/view/journals/jnccn/19/7/article-p839.xml

YANG G , JI M , CHEN J , et al . Surgery management for sporadic small (≤2 cm), non-functioning pancreatic neuroendocrine tumors: a consensus statement by the Chinese Study Group for Neuroendocrine Tumors (CSNET) [J ] . Int J Oncol , 2017 , 50 ( 2 ): 567 - 574 . DOI: 10.3892/ijo.2016.3826 http://doi.org/10.3892/ijo.2016.3826

Views

2370

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Application of three-dimensional thoracoscope system in minimally invasive thoracic surgery

Related Author

乔文亮

周建华

刘法兵

Related Institution

上海交通大学附属第一人民医院胸外科

AI问答

⁰