Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Internal Medicine Neurology Oncology Pediatrics Respiratory Medicine Surgery
Congress Coverage
2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting

Keynote Webinar | Spotlight on Diet and Diabetes

Watch on-demand

An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. 
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
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

Login to get access

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.
Literature
1.
Asbun HJ, Moekotte AL, Vissers FL, et al. The Miami International Evidence-based Guidelines on minimally invasive pancreas resection. Ann Surg. 2020;271(1):1–14. CrossRefPubMed
2.
de Rooij T, van Hilst J, van Santvoort H, et al. Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg. 2019;269(1):2–9. CrossRefPubMed
3.
Bjornsson B, Larsson AL, Hjalmarsson C, Gasslander T, Sandstrom P. Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial. Br J Surg. 2020;107(10):1281–8. CrossRefPubMed
4.
Abu Hilal M, Takhar AS. Laparoscopic left pancreatectomy: current concepts. Pancreatology. 2013;13(4):443–8. CrossRefPubMed
5.
van Hilst J, de Rooij T, Klompmaker S, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Ann Surg. 2019;269(1):10–7. CrossRefPubMed
6.
Raoof M, Nota C, Melstrom LG, et al. Oncologic outcomes after robot-assisted versus laparoscopic distal pancreatectomy: analysis of the National Cancer Database. J Surg Oncol. 2018;118(4):651–6. CrossRefPubMedPubMedCentral
7.
Zhou JY, Xin C, Mou YP, et al. Robotic versus laparoscopic distal pancreatectomy: a meta-analysis of short-term outcomes. PLoS One. 2016;11(3):e0151189. CrossRefPubMedPubMedCentral
8.
Lof S, van der Heijde N, Abuawwad M, et al. Robotic versus laparoscopic distal pancreatectomy: multicentre analysis. Br J Surg. 2021;108(2):188–95. CrossRefPubMed
9.
Lyman WB, Passeri M, Sastry A, et al. Robotic-assisted versus laparoscopic left pancreatectomy at a high-volume, minimally invasive center. Surg Endosc. 2019;33(9):2991–3000. CrossRefPubMed
10.
Lof S, Korrel M, van Hilst J, et al. Outcomes of elective and emergency conversion in minimally invasive distal pancreatectomy for pancreatic ductal adenocarcinoma: an international multicenter propensity score-matched study. Ann Surg. 2021;274(6):e1001–7.
11.
Qu L, Zhiming Z, Xianglong T, et al. Short- and mid-term outcomes of robotic versus laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma: a retrospective propensity score-matched study. Int J Surg. 2018;55:81–8. CrossRefPubMed
12.
Chopra A, Nassour I, Zureikat A, Paniccia A. Perioperative and oncologic outcomes of open, laparoscopic, and robotic distal pancreatectomy for pancreatic adenocarcinoma. Updates Surg. 2021;73(3):947–53. CrossRefPubMed
13.
Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2017;15(8):1028–61. CrossRefPubMed
14.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. CrossRef
15.
Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76(2):182–8. CrossRefPubMed
16.
Lof S, Vissers FL, Klompmaker S, et al. Risk of conversion to open surgery during robotic and laparoscopic pancreatoduodenectomy and effect on outcomes: international propensity score-matched comparison study. Br J Surg. 2021;108(1):80–7. CrossRefPubMed
17.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. CrossRefPubMedPubMedCentral
18.
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584–91. CrossRefPubMed
19.
Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8. CrossRefPubMed
20.
Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5. CrossRefPubMed
21.
Campbell FFA, Verbeke C. Dataset for the histopathological reporting of carcinomas of the pancreas, ampulla of Vater and common bile duct 2010(261035):1–27.
22.
Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley JD, Gaspar LE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M, Gress DM, Meyer LR (eds). AJCC Cancer Staging Manual. Vol 8: Springer International Publishing; 2017.
23.
van Hilst J, Korrel M, Lof S, et al. Minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma (DIPLOMA): study protocol for a randomized controlled trial. Trials. 2021;22(1):608. CrossRefPubMedPubMedCentral
24.
Feng Q, Jiang C, Feng X, et al. Robotic versus laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Front Oncol. 2021;11:752236. CrossRefPubMedPubMedCentral
25.
Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg. 2013;257(1):128–32. CrossRefPubMed
26.
Liu R, Liu Q, Zhao ZM, Tan XL, Gao YX, Zhao GD. Robotic versus laparoscopic distal pancreatectomy: a propensity score-matched study. J Surg Oncol. 2017;116(4):461–9. CrossRefPubMed
27.
Xu SB, Jia CK, Wang JR, Zhang RC, Mou YP. Do patients benefit more from robot assisted approach than conventional laparoscopic distal pancreatectomy? A meta-analysis of perioperative and economic outcomes. J Formos Med Assoc. 2019;118(1 Pt 2):268–78. CrossRefPubMed
28.
Wang HB, Xiong GB, Zhu F, et al. Clavien-Dindo classification and influencing factors analysis of complications after laparoscopic pancreaticoduodenectomy. Zhonghua Wai Ke Za Zhi. 2018;56(11):828–32. PubMed
29.
Sahakyan MA, Tholfsen T, Kleive D, et al. Laparoscopic distal pancreatectomy in patients with poor physical status. HPB (Oxford). 2021;23(6):877–81. CrossRefPubMed
30.
Feo CF, Deiana G, Ninniri C, et al. Vascular resection for locally advanced pancreatic ductal adenocarcinoma: analysis of long-term outcomes from a single-centre series. World J Surg Oncol. 2021;19(1):126. CrossRefPubMedPubMedCentral
31.
Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg. 2015;262(2):372–7. CrossRefPubMed
32.
Sharpe SM, Talamonti MS, Wang CE, et al. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg. 2015;221(1):175–84. CrossRefPubMed
33.
Sahakyan MA, Haugvik SP, Rosok BI, et al. Can standardized pathology examination increase the lymph node yield following laparoscopic distal pancreatectomy for ductal adenocarcinoma? HPB (Oxford). 2018;20(2):175–81. CrossRefPubMed
34.
Korrel M, Lof S, van Hilst J, et al. Predictors for survival in an international cohort of patients undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2021;28(2):1079–87. CrossRefPubMed
35.
Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379(25):2395–406. CrossRefPubMed
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

Other articles of this Issue 5/2023

Annals of Surgical Oncology 5/2023 Go to the issue

ASO Visual Abstract

ASO Visual Abstract: Impact of Age on Treatment and Survival in Esophagogastric Cancer

Hepatobiliary Tumors

A Model to Predict Treatment Failure in Patients Undergoing Upfront Surgery for Resectable Colorectal Liver Metastases

ASO Author Reflections

ASO Author Reflections: Evolution of Surgical Techniques Through Robotic Surgery Technology

Aso Author Reflections

ASO Author Reflections: Viral Hepatitis on Post-Hepatectomy Outcomes in the Direct-Acting Antivirals Era

Peritoneal Surface Malignancy

PD-1 Blockade Combined with Heated Intraperitoneal Chemotherapy Improves Outcome in Experimental Peritoneal Metastases from Colonic Origin in a Murine Model

Sarcoma

Prognostic Factors and Clinical Outcomes in Extraskeletal Ewing Sarcoma: A Cohort Study