Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 5/2021

Open Access 01-05-2021 | Pancreatectomy

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

Authors: Yuanchi Weng, Jiabin Jin, Zhen Huo, Yusheng Shi, Yu Jiang, Xiaxing Deng, Chenghong Peng, Baiyong Shen

Published in: Surgical Endoscopy | Issue 5/2021

Login to get access

Abstract

Background

This study aimed to compare the short-term outcomes of open and robotic-assisted distal pancreatectomy (ODP and RDP) for benign and low-grade malignant tumors.

Methods

The patients who underwent RDP and ODP for benign or low-grade malignant pancreatic tumors at our center were included. After PSM at a 1:1 ratio, the perioperative variations in the two cohorts were compared.

Results

After 1:1 PSM, 219 cases of RDP and ODP were recorded. The RDP cohort showed advantages in the operative duration [120 (90–150) min vs 175 (130–210) min, P < 0.001], estimated blood loss [50 (30–175) ml vs 200 (100–300) ml, P < 0.001], spleen preservation rate (63.5% vs 26.5%, P < 0.001), infection rate (4.6% vs 12.3%, P = 0.006), and gastrointestinal function recovery [3 (2–4) vs. 3 (3–5), P = 0.019]. There were no significant differences in postoperative pancreatic fistula, postoperative hemorrhage, and delayed gastric emptying. Multivariate analysis showed that RDP (HR 0.24; 95% CI 0.16–0.36, P < 0.001), age (HR 1.02; 95% CI 1.00–1.03, P = 0.033), tumor size (HR 1.28; 95% CI 1.17–1.40, P < 0.001), pathological inflammatory neoplasm type (HR 5.12; 95% CI 2.22–11.81, P < 0.001), and estimated blood loss (HR 1.003; 95% CI 1.001–1.004, P < 0.001) were independent predictors of spleen preservation; RDP (HR 0.27; 95% CI 0.17–0.43, P < 0.001), age (HR 1.02; 95% CI 1.00–1.03, P = 0.022), elevated CA 19–9 level (HR 2.55; 95% CI 1.02–6.39, P = 0.046), tumor size (HR 1.44; 95% CI 1.29–1.61, P < 0.001), pathological inflammatory neoplasm type (HR 4.48; 95% CI 1.69–11.85, P = 0.003), and estimated blood loss (HR 1.003; 95% CI 1.001–1.004, P < 0.001) were independent predictors of spleen preservation with the Kimura technique.

Conclusion

RDP has advantages in the operative time, blood loss, spleen preservation, infection rate, and gastrointestinal function recovery over ODP in treating benign and low-grade malignant pancreatic tumors. The robotic-assisted approach was an independent predictor of spleen preservation and use of the Kimura technique.
Appendix
Available only for authorised users
Literature
1.
Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054PubMed
2.
Lyman WB, Passeri M, Sastry A et al (2019) Robotic-assisted versus laparoscopic left pancreatectomy at a high-volume, minimally invasive center. Surg Endosc 33:2991–3000PubMed
3.
Magge DR, Zenati MS, Hamad A et al (2018) Comprehensive comparative analysis of cost-effectiveness and perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy. HPB 20:1172–1180PubMed
4.
Yang DJ, Xiong JJ, Lu HM et al (2019) The oncological safety in minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Sci Rep 9:1159PubMedPubMedCentral
5.
6.
Qu L, Zhiming Z, Xianglong T et al (2018) Short- and mid-term outcomes of robotic versus laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma: a retrospective propensity score-matched study. Int J Surg 55:81–86PubMed
7.
Asbun HJ, Moekotte AL, Vissers FL et al (2020) The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 271:1–14PubMed
8.
Shi N, Liu SL, Li YT et al (2016) Splenic preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol 23:365–374PubMed
9.
Pendola F, Gadde R, Ripat C et al (2017) Distal pancreatectomy for benign and low grade malignant tumors: short-term postoperative outcomes of spleen preservation—a systematic review and update meta-analysis. J Surg Oncol 115:137–143PubMed
10.
He Z, Qian D, Hua J et al (2014) Clinical comparison of distal pancreatectomy with or without splenectomy: a meta-analysis. PLoS ONE 9:e91593PubMedPubMedCentral
11.
Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553PubMed
12.
Kimura W, Inoue T, Futakawa N et al (1996) Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery 120:885–890PubMed
13.
Miura F, Takada T, Asano T et al (2005) Hemodynamic changes of splenogastric circulation after spleenpreserving pancreatectomy with excision of splenic artery and vein. Surgery 138:518–522PubMed
14.
Sarin SK, Lahoti D, Saxena SP et al (1992) Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 16:1343–1349PubMed
15.
Balzano G, Zerbi A, Di Carlo V (2007) Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a cautionary note. World J Surg 31:1530PubMed
16.
von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457
17.
Shakir M, Boone BA, Polanco PM et al (2015) The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB 17:580–586PubMedPubMedCentral
18.
Napoli N, Kauffmann EF, Perrone VG et al (2015) The learning curve in robotic distal pancreatectomy. Updates Surg 67:257–264PubMed
19.
Chen S, Zhan Q, Chen JZ et al (2015) Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc 29:3507–3518PubMed
20.
Kuza CM, Hatzakis G, Nahmias JT (2017) The assignment of American Society of Anesthesiologists physical status classification for adult polytrauma patients: results from a survey and future considerations. Anesth Analg 125:1960–1966PubMed
21.
Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591PubMed
22.
Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25PubMed
23.
Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768PubMed
24.
Sawyer RG, Claridge JA, Nathens AB et al (2015) Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 372:1996–2005PubMedPubMedCentral
25.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedPubMedCentral
26.
Sánchez-Cabús S, Adam JP, Pittau G et al (2016) Laparoscopic left pancreatectomy: early results after 115 consecutive patients. Surg Endosc 30:4480–4488PubMed
27.
Jean-Philippe A, Alexandre J, Christophe L et al (2013) Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg 148:246–252
28.
de Rooij T, Klompmaker S, Abu Hilal M et al (2016) Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol 13:227–238PubMed
29.
30.
Huang B, Feng L, Zhao J (2016) Systematic review and meta-analysis of robotic versus laparoscopic distal pancreatectomy for benign and malignant pancreatic lesions. Surg Endosc 30:4078–4085PubMed
31.
Gavriilidis P, Lim C, Menahem B et al (2016) Robotic versus laparoscopic distal pancreatectomy—the first meta-analysis. HPB 18:567–574PubMedPubMedCentral
32.
Zhou JY, Xin C, Mou YP et al (2016) Robotic versus laparoscopic distal pancreatectomy: a meta-analysis of short-term outcomes. PLoS ONE 11:e0151189PubMedPubMedCentral
33.
Daouadi M, Zureikat AH, Zenati MS et al (2013) Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 257:128–132PubMed
34.
Butturini G, Damoli I, Crepaz L et al (2015) A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc 29:3163–3170PubMed
35.
Austin PC (2011) Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples. Stat Med 30:1292–1301PubMedPubMedCentral
36.
Marino MV, Shabat G, Gulotta G et al (2018) From illusion to reality: a brief history of robotic surgery. Surg Innov 25:291–296PubMed
37.
Giulianotti PC, Sbrana F, Bianco FM et al (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657PubMed
38.
Kang CM, Kim DH, Lee WJ et al (2011) Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 25:2004–2009PubMed
39.
Ito M, Asano Y, Shimizu T et al (2014) Comparison of standard laparoscopic distal pancreatectomy with minimally invasive distal pancreatectomy using the da Vinci S system. Hepatogastroenterology 61:493–496PubMed
40.
Guerrini GP, Lauretta A, Belluco C et al (2017) Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg 17:105PubMedPubMedCentral
41.
Shoup M, Brennan MF, McWhite K et al (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137:164–168PubMed
42.
Benoist S, Dugué L, Sauvanet A et al (1999) Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 188:255–260PubMed
43.
Butturini G, Inama M, Malleo G et al (2012) Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis. J Surg Oncol 105:387–392PubMed
44.
Worhunsky DJ, Zak Y, Dua MM et al (2014) Laparoscopic spleen-preserving distal pancreatectomy: the technique must suit the lesion. J Gastrointest Surg 18:1445–1451PubMed
45.
Eckhardt S, Schicker C, Maurer E et al (2016) Robotic-assisted approach improves vessel preservation in spleen-preserving distal pancreatectomy. Dig Surg 33:406–413PubMed
46.
Miura F, Takada T, Asano T et al (2005) Hemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein. Surgery 138:518–522PubMed
47.
Binicier OB, Pakoz ZB (2019) CA 19–9 levels in patients with acute pancreatitis due to gallstone and metabolic/toxic reasons. Rev Assoc Med Bras 65:965–970PubMed
48.
Gavriilidis P, Roberts KJ, Sutcliffe RP (2019) Comparison of robotic vs laparoscopic vs open distal pancreatectomy. A systematic review and network meta-analysis. HPB 21:1268–1276PubMed
Metadata
Title
Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study
Authors
Yuanchi Weng
Jiabin Jin
Zhen Huo
Yusheng Shi
Yu Jiang
Xiaxing Deng
Chenghong Peng
Baiyong Shen
Publication date
01-05-2021
Publisher
Springer US
Keyword
Pancreatectomy
Published in
Surgical Endoscopy / Issue 5/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07639-9

Other articles of this Issue 5/2021

Surgical Endoscopy 5/2021 Go to the issue

OriginalPaper

Positive consequences of splenectomy for patients with schistosomiasis-induced variceal bleeding

OriginalPaper

Recovery after laparoscopic parastomal hernia repair

OriginalPaper

Results of video-assisted thoracic surgery versus thoracotomy in surgical resection of pN2 non-small cell lung cancer in a Chinese high-volume Center

Dynamic Manuscript

Laparoscopic middle colic artery-preserved right hemicolectomy with true D3 lymph node dissection for right-sided colon cancer: modified complete mesocolic excision

OriginalPaper

Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison

OriginalPaper

Accuracy of endoscopic size measurements of early gastric signet ring cell carcinoma