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Published in: Annals of Surgical Oncology 5/2023

Open Access 17-02-2023 | Pancreatectomy | Pancreatic Tumors

Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International, Retrospective, Cohort Study

Authors: Jeffrey W. Chen, MD, Tess M. E. van Ramshorst, MD, Sanne Lof, MD, PhD, Bilal Al-Sarireh, MD, PhD, Bergthor Bjornsson, MD, PhD, Ugo Boggi, MD, Fernando Burdio, MD, PhD, Giovanni Butturini, MD, PhD, Riccardo Casadei, MD, PhD, Andrea Coratti, MD, PhD, Mathieu D’Hondt, MD, PhD, Safi Dokmak, MD, PhD, Bjørn Edwin, MD, PhD, Alessandro Esposito, MD, Jean M. Fabre, MD, PhD, Giovanni Ferrari, MD, PhD, Fadhel S. Ftériche, MD, PhD, Giuseppe K. Fusai, MD, PhD, Bas Groot Koerkamp, MD, PhD, Thilo Hackert, MD, PhD, Asif Jah, MD, Jin-Young Jang, MD, PhD, Emanuele F. Kauffmann, MD, PhD, Tobias Keck, MD, PhD, Alberto Manzoni, MD, Marco V. Marino, MD, PhD, Quintus Molenaar, MD, PhD, Elizabeth Pando, MD, PhD, Patrick Pessaux, MD, PhD, Andrea Pietrabissa, MD, PhD, Zahir Soonawalla, MD, PhD, Robert P. Sutcliffe, MD, Lea Timmermann, MD, PhD, Steven White, MD, PhD, Vincent S. Yip, MD, PhD, Alessandro Zerbi, MD, Mohammad Abu Hilal, MD, PhD, Marc G. Besselink, MD, PhD, For the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

Published in: Annals of Surgical Oncology | Issue 5/2023

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Abstract

Background

Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking.

Methods

An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010–2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival.

Results

In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p < 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively.

Conclusions

In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials.
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Metadata
Title
Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International, Retrospective, Cohort Study
Authors
Jeffrey W. Chen, MD
Tess M. E. van Ramshorst, MD
Sanne Lof, MD, PhD
Bilal Al-Sarireh, MD, PhD
Bergthor Bjornsson, MD, PhD
Ugo Boggi, MD
Fernando Burdio, MD, PhD
Giovanni Butturini, MD, PhD
Riccardo Casadei, MD, PhD
Andrea Coratti, MD, PhD
Mathieu D’Hondt, MD, PhD
Safi Dokmak, MD, PhD
Bjørn Edwin, MD, PhD
Alessandro Esposito, MD
Jean M. Fabre, MD, PhD
Giovanni Ferrari, MD, PhD
Fadhel S. Ftériche, MD, PhD
Giuseppe K. Fusai, MD, PhD
Bas Groot Koerkamp, MD, PhD
Thilo Hackert, MD, PhD
Asif Jah, MD
Jin-Young Jang, MD, PhD
Emanuele F. Kauffmann, MD, PhD
Tobias Keck, MD, PhD
Alberto Manzoni, MD
Marco V. Marino, MD, PhD
Quintus Molenaar, MD, PhD
Elizabeth Pando, MD, PhD
Patrick Pessaux, MD, PhD
Andrea Pietrabissa, MD, PhD
Zahir Soonawalla, MD, PhD
Robert P. Sutcliffe, MD
Lea Timmermann, MD, PhD
Steven White, MD, PhD
Vincent S. Yip, MD, PhD
Alessandro Zerbi, MD
Mohammad Abu Hilal, MD, PhD
Marc G. Besselink, MD, PhD
For the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
Publication date
17-02-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-13054-2

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