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BMC Surgery
Published in: BMC Surgery 1/2017

Open Access 01-12-2017 | Research article

Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis

Authors: Gian Piero Guerrini, Andrea Lauretta, Claudio Belluco, Matteo Olivieri, Marco Forlin, Stefania Basso, Bruno Breda, Giulio Bertola, Fabrizio Di Benedetto

Published in: BMC Surgery | Issue 1/2017

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Abstract

Background

Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe that robotic surgery can overcome the difficulties and technical limits of LDP thanks to improved surgical manipulation and better visualization. Few studies in the literature have compared the two methods in terms of surgical and oncological outcome. The aim of this study was to compare the results of robotic (RDP) and laparoscopic distal pancreatectomy.

Methods

A systematic review and meta-analysis was conducted of control studies published up to December 2016 comparing LDP and RDP. Two Reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model.

Results

Ten studies describing 813 patients met the inclusion criteria. This meta-analysis shows that the RDP group had a significantly higher rate of spleen preservation [OR 2.89 (95% confidence interval 1.78-4.71, p < 0.0001], a lower rate of conversion to open OR 0.33 (95% CI 0.12-0.92), p = 0.003] and a shorter hospital stay [MD -0.74; (95% CI -1.34 -0.15), p = 0.01] but a higher cost than the LDP group, while other surgical outcomes did not differ between the two groups.

Conclusion

This meta-analysis suggests that the RDP procedure is safe and comparable in terms of surgical results to LDP. However, even if the RDP has a higher cost compared to LDP, it increases the rate of spleen preservation, reduces the risk of conversion to open surgery and is associated to shorter length of hospital stay.
Literature
1.
2.
3.
Wellner UF, Lapshyn H, Bartsch DK, Mintziras I, Hopt UT, Wittel U, Kramling HJ, Preissinger-Heinzel H, Anthuber M, Geissler B, et al. Laparoscopic versus open distal pancreatectomy-a propensity score-matched analysis from the German StuDoQ|pancreas registry. Int J Color Dis. 2017;32(2):273–80.CrossRef
4.
Borja-Cacho D, Al-Refaie WB, Vickers SM, Tuttle TM, Jensen EH. Laparoscopic distal pancreatectomy. J Am Coll Surg. 2009;209(6):758–65. quiz 800CrossRefPubMed
5.
Sulpice L, Farges O, Goutte N, Bendersky N, Dokmak S, Sauvanet A, Delpero JR and ACHBT French Pancreatectomy Study Group. Laparoscopic distal Pancreatectomy for pancreatic Ductal Adenocarcinoma: time for a randomized controlled trial? Results of an all-inclusive National Observational Study. Ann Surg. 2015;262(5):868-73.
6.
Cuschieri A, Jakimowicz JJ, van Spreeuwel J. Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg. 1996;223(3):280–5.CrossRefPubMedPubMedCentral
7.
Jin T, Altaf K, Xiong JJ, Huang W, Javed MA, Mai G, Liu XB, WM H, Xia Q. A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB (Oxford). 2012;14(11):711–24.CrossRef
8.
Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc. 2012;26(4):904–13.CrossRefPubMed
9.
Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR, van Laarhoven CJ. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev. 2016, Apr 4;4:CD011391.PubMed
10.
Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 2012;255(6):1048–59.CrossRefPubMed
11.
Cirocchi R, Partelli S, Coratti A, Desiderio J, Parisi A, Falconi M. Current status of robotic distal pancreatectomy: a systematic review. Surg Oncol. 2013;22(3):201–7.CrossRefPubMed
12.
Strijker M, van Santvoort HC, Besselink MG, van Hillegersberg R, Borel Rinkes IH, Vriens MR, Molenaar IQ. Robot-assisted pancreatic surgery: a systematic review of the literature. HPB (Oxford). 2013;15(1):1–10.CrossRef
13.
Melvin WS, Needleman BJ, Krause KR, Ellison EC. Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A. 2003;13(1):33–6.CrossRefPubMed
14.
Jung MK, Buchs NC, Azagury DE, Hagen ME, Morel P. Robotic distal pancreatectomy: a valid option? Minerva Chir. 2013;68(5):489–97.PubMed
15.
Magge D, Zureikat A, Hogg M, Zeh HJ 3rd. Minimally invasive approaches to pancreatic surgery. Surg Oncol Clin N Am. 2016;25(2):273–86.CrossRefPubMed
16.
Balzano G, Bissolati M, Boggi U, Bassi C, Zerbi A, Falconi M. A multicenter survey on distal pancreatectomy in Italy: results of minimally invasive technique and variability of perioperative pathways. Updat Surg. 2014;66(4):253–63.CrossRef
17.
Chen S, Zhan Q, Chen JZ, Jin JB, Deng XX, Chen H, Shen BY, Peng CH, Li HW. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc. 2015;29(12):3507–18.CrossRefPubMed
18.
Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg. 2013;257(1):128–32.CrossRefPubMed
19.
Duran H, Ielpo B, Caruso R, Ferri V, Quijano Y, Diaz E, Fabra I, Oliva C, Olivares S, Vicente E. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot. 2014;10(3):280–5.CrossRefPubMed
20.
Goh BK, Chan CY, Soh HL, Lee SY, Cheow PC, Chow PK, Ooi LL, Chung AY. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. Int J Med Robot. 2017;13(1) epub.
21.
Ito M, Asano Y, Shimizu T, Uyama I, Horiguchi A. Comparison of standard laparoscopic distal pancreatectomy with minimally invasive distal pancreatectomy using the da Vinci S system. Hepato-Gastroenterology. 2014;61(130):493–6.PubMed
22.
Kang CM, Kim DH, Lee WJ, Chi HS. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc. 2011;25(6):2004–9.CrossRefPubMed
23.
Lai EC, Tang CN. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes. Front Med. 2015;9(3):356–60.CrossRefPubMed
24.
Lee SY, Allen PJ, Sadot E, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Kingham TP. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg. 2015;220(1):18–27.CrossRefPubMed
25.
Butturini G, Damoli I, Crepaz L, Malleo G, Marchegiani G, Daskalaki D, Esposito A, Cingarlini S, Salvia R, Bassi C. A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc. 2015;29(11):3163–70.CrossRefPubMed
26.
Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, et al. Robotic distal pancreatectomy: cost effective? Surgery. 2010;148(4):814–23.CrossRefPubMed
27.
Zhou JY, Xin C, Mou YP, XW X, Zhang MZ, Zhou YC, Lu C, Chen RG. Robotic versus laparoscopic distal Pancreatectomy: a meta-analysis of short-term outcomes. PLoS One. 2016;11(3):e0151189.CrossRefPubMedPubMedCentral
28.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed
29.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRefPubMedPubMedCentral
30.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMed
31.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.CrossRefPubMed
32.
Vonlanthen R, Slankamenac K, Breitenstein S, Puhan MA, Muller MK, Hahnloser D, Hauri D, Graf R, Clavien PA. The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg. 2011;254(6):907–13.CrossRefPubMed
33.
Al-Taan OS, Stephenson JA, Briggs C, Pollard C, Metcalfe MS, Dennison AR. Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford). 2010;12(4):239–43.CrossRef
34.
Mesleh MG, Stauffer JA, Asbun HJ. Minimally invasive surgical techniques for pancreatic cancer: ready for prime time? J Hepatobiliary Pancreat Sci. 2013;20(6):578–82.CrossRefPubMed
35.
Edwin B, Sahakyan MA, Hilal MA, Besselink MG, Braga M, Fabre JM, Fernandez-Cruz L, Gayet B, Kim SC, Khatkov IE. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc. 2017;31(5):2023–41.CrossRefPubMed
36.
de Rooij T, Klompmaker S, Abu Hilal M, Kendrick ML, Busch OR, Besselink MG. Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol. 2016;13(4):227–38.CrossRefPubMed
37.
Kang CM, Lee SH, Lee WJ. Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: current status and future perspectives. World J Gastroenterol. 2014;20(9):2343–51.CrossRefPubMedPubMedCentral
38.
Kendrick ML. Laparoscopic and robotic resection for pancreatic cancer. Cancer J. 2012;18(6):571–6.CrossRefPubMed
39.
Eckhardt S, Schicker C, Maurer E, Fendrich V, Bartsch DK. Robotic-assisted approach improves vessel preservation in spleen-preserving distal Pancreatectomy. Dig Surg. 2016;33(5):406–13.CrossRefPubMed
40.
Doi R. Determinants of surgical resection for pancreatic neuroendocrine tumors. J Hepatobiliary Pancreat Sci. 2015;22(8):610–7.CrossRefPubMed
41.
Kimura W, Inoue T, Futakawa N, Shinkai H, Han I, Muto T. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery. 1996;120(5):885–90.CrossRefPubMed
42.
43.
Baker MS, Bentrem DJ, Ujiki MB, Stocker S, Talamonti MS. A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery. 2009;146(4):635–43. discussion 643-635CrossRefPubMed
44.
Adam U, Makowiec F, Riediger H, Trzeczak S, Benz S, Hopt UT. Distal pancreatic resection--indications, techniques and complications. Zentralbl Chir. 2001;126(11):908–12.CrossRefPubMed
45.
Wilson C, Robinson S, French J, White S. Strategies to reduce pancreatic stump complications after open or laparoscopic distal pancreatectomy. Surg Laparosc Endosc Percutan Tech. 2014;24(2):109–17.CrossRefPubMed
46.
Mahvi D. Defining, controlling, and treating a pancreatic fistula. J Gastrointest Surg. 2009;13(7):1187–8.CrossRefPubMed
47.
Miyasaka Y, Mori Y, Nakata K, Ohtsuka T, Nakamura M. Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy. Surg Today. 2017;47(4):416–24.CrossRefPubMed
48.
Zhou W, Lv R, Wang X, Mou Y, Cai X, Herr I. Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg. 2010;200(4):529–36.CrossRefPubMed
49.
Partelli S, Cirocchi R, Randolph J, Parisi A, Coratti A, Falconi M. A systematic review and meta-analysis of spleen-preserving distal pancreatectomy with preservation or ligation of the splenic artery and vein. Surgeon. 2016;14(2):109–18.CrossRefPubMed
50.
Nakamura M, Nakashima H. Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci. 2013;20(4):421–8.CrossRefPubMed
Metadata
Title
Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis
Authors
Gian Piero Guerrini
Andrea Lauretta
Claudio Belluco
Matteo Olivieri
Marco Forlin
Stefania Basso
Bruno Breda
Giulio Bertola
Fabrizio Di Benedetto
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2017
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-017-0301-3

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