基于倾向性评分匹配的机器人辅助腹腔镜与腹腔镜胆道恶性肿瘤根治术短期结局比较OA北大核心

Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM). Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay. Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay. Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.