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01-06-2019 | Pancreatectomy | Original Article

Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study

Authors: Sergio Alfieri, Giovanni Butturini, Ugo Boggi, Andrea Pietrabissa, Luca Morelli, Fabio Vistoli, Isacco Damoli, Andrea Peri, Claudio Fiorillo, Luigi Pugliese, Marco Ramera, Nelide De Lio, Gregorio Di Franco, Alessandro Esposito, Luca Landoni, Fausto Rosa, Roberta Menghi, Giovanni Battista Doglietto, Giuseppe Quero, The Italian Robotic pNET Group

Published in: Langenbeck's Archives of Surgery | Issue 4/2019

Abstract

Purpose

Minimally invasive surgery has increasingly gained popularity as a treatment of choice for pancreatectomy with encouraging initial results in robotic distal pancreatectomy (RDP). However, few data are available on the comparison between RDP and laparoscopic distal pancreatectomy (LDP) for pancreatic neuroendocrine tumors (pNETs). Our aim, thus, is to compare perioperative and long-term outcomes as well as total costs of RDP and LDP for pNETs.

Methods

All RDPs and LDPs for pNETs performed in four referral centers from 2008 to 2016 were included. Perioperative outcomes, histopathological results, overall (OS) and disease-free survival (DFS), and total costs were evaluated.

Results

Ninety-six RDPs and 85 LDPs were included. Demographic and clinical characteristics were comparable between the two cohorts. Operative time was 36.5 min longer in the RDP group (p = 0.009) but comparable to LDP after removing the docking time (247.9 vs 233.7 min; p = 0.6). LDP related to a lower spleen preservation rate (44.7% vs 65.3%; p < 0.0001) and higher blood loss (239.7 ± 112 vs 162.5 ± 98 cc; p < 0.0001). Advantages in operative time for RDP were documented in case of the spleen preservation procedures (265 ± 41.52 vs 291 ± 23 min; p = 0.04). Conversion rate, postoperative morbidity, and pancreatic fistula rate were similar between the two groups, as well as histopathological data, OS, and DFS. Significant advantages were evidenced for LDP regarding mean total costs (9235 (± 1935) € vs 11,226 (± 2365) €; p < 0.0001).

Conclusions

Both RDP and LDP are safe and efficacious for pNETs treatment. However, RDP offers advantages with a higher spleen preservation rate and lower blood loss. Costs still remain the main limitation of the robotic approach.

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Title: Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study
Authors: Sergio Alfieri
Giovanni Butturini
Ugo Boggi
Andrea Pietrabissa
Luca Morelli
Fabio Vistoli
Isacco Damoli
Andrea Peri
Claudio Fiorillo
Luigi Pugliese
Marco Ramera
Nelide De Lio
Gregorio Di Franco
Alessandro Esposito
Luca Landoni
Fausto Rosa
Roberta Menghi
Giovanni Battista Doglietto
Giuseppe Quero
The Italian Robotic pNET Group
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatectomy
Neuroendocrine Tumor
Published in: Langenbeck's Archives of Surgery / Issue 4/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-019-01786-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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