Top

Published in:

01-05-2020 | Pancreatoduodenostomy | Original Article

Robotic Pancreaticoduodenectomy Is Associated with Decreased Clinically Relevant Pancreatic Fistulas: a Propensity-Matched Analysis

Authors: Jianpeng Cai, Rajesh Ramanathan, Mazen S. Zenati, Amr Al Abbas, Melissa E. Hogg, Herbert J. Zeh, Amer H. Zureikat

Published in: Journal of Gastrointestinal Surgery | Issue 5/2020

Abstract

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD) is a major complication that adversely affects recovery. The robotic approach may decrease the incidence of this complication. This propensity-matched analysis evaluates the impact of robotic PD (RPD) on CR-POPF.

Methods

Patients undergoing PD after the learning curve at a high-volume academic medical center were reviewed. CR-POPF outcomes after open PD (OPD) and RPD were compared. Logistic regression and propensity score matching (PSM) were used to define the independent effect of RPD on CR-POPF.

Results

Of 865 PDs performed over the study period, 405 (46.8%) were OPD and 460 (53.2%) were RPD. RPD was associated with a similar overall POPF rate, but a lower incidence of CR-POPF (6.7% vs. 15.8%, p < 0.001). On multivariate analysis, RPD was an independent predictor of lower CR-POPF (OR 0.278, p < 0.001). Following propensity matching, RPD continued to be protective against the occurrence of CR-POPF (coefficient = − 0.113, p = 0.001).

Conclusions

This is the largest single-center PSM analysis to evaluate the impact of robotic approach on pancreatoduodenectomy and suggests that RPD can minimize the clinical impact of pancreatic leaks after PD.

Nappo G, Perinel J, El Bechwaty M, Adham M. The Standardization of Pancreatoduodenectomy: Where Are We? Pancreas. 2016;45(4):493–502. doi:https://doi.org/10.1097/MPA.0000000000000503 CrossRefPubMed

Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg. 2007;245(3):443–451. doi:https://doi.org/10.1097/01.sla.0000251708.70219.d2 CrossRefPubMedPubMedCentral

Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14. doi:https://doi.org/10.1016/j.jamcollsurg.2012.09.002 CrossRefPubMed

Hu B-Y, Wan T, Zhang W-Z, Dong J-H. Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy. World J Gastroenterol. 2016;22(34):7797–7805. doi:https://doi.org/10.3748/wjg.v22.i34.7797 CrossRefPubMedPubMedCentral

Malleo G, Pulvirenti A, Marchegiani G, Butturini G, Salvia R, Bassi C. Diagnosis and management of postoperative pancreatic fistula. Langenbecks Arch Surg. 2014;399(7):801–810. doi:https://doi.org/10.1007/s00423-014-1242-2 CrossRefPubMed

Tseng JF, Pisters PWT, Lee JE, et al. The learning curve in pancreatic surgery. Surgery. 2007;141(5):694–701.CrossRefPubMed

McMillan MT, Soi S, Asbun HJ, et al. Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation. Ann Surg. 2016;264(2):344–352. doi:https://doi.org/10.1097/SLA.0000000000001537 CrossRefPubMed

Zureikat AH, Postlewait LM, Liu Y, et al. A Multi-institutional Comparison of Perioperative Outcomes of Robotic and Open Pancreaticoduodenectomy. Ann Surg. 2016;264(4):640–649. doi:https://doi.org/10.1097/SLA.0000000000001869 CrossRefPubMed

Girgis MD, Zenati MS, Steve J, et al. Robotic approach mitigates perioperative morbidity in obese patients following pancreaticoduodenectomy. HPB (Oxford). 2017;19(2):93–98. doi:https://doi.org/10.1016/j.hpb.2016.11.008 CrossRefPubMed

10.

Magge D, Zenati M, Lutfi W, et al. Robotic pancreatoduodenectomy at an experienced institution is not associated with an increased risk of post-pancreatic hemorrhage. HPB (Oxford). 2018;20(5):448–455. doi:https://doi.org/10.1016/j.hpb.2017.11.005 CrossRefPubMed

11.

McMillan MT, Zureikat AH, Hogg ME, et al. A Propensity Score-Matched Analysis of Robotic vs Open Pancreatoduodenectomy on Incidence of Pancreatic Fistula. JAMA Surg. 2017;152(4):327–335. doi:https://doi.org/10.1001/jamasurg.2016.4755 CrossRefPubMedPubMedCentral

12.

Boone BA, Zenati M, Hogg ME, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg. 2015;150(5):416–422. doi:https://doi.org/10.1001/jamasurg.2015.17 CrossRefPubMed

13.

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):584–591. doi:https://doi.org/10.1016/j.surg.2016.11.014 CrossRefPubMed

14.

Felder SI, Ramanathan R, Russo AE, et al. Robotic gastrointestinal surgery. Curr Probl Surg. 2018;55(6):198–246. doi:https://doi.org/10.1067/j.cpsurg.2018.07.001 CrossRefPubMedPubMedCentral

15.

Grobmyer SR, Kooby D, Blumgart LH, Hochwald SN. Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. J Am Coll Surg. 2010;210(1):54–59. doi:https://doi.org/10.1016/j.jamcollsurg.2009.09.020 CrossRefPubMed

16.

Sterne JAC, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393. doi:https://doi.org/10.1136/bmj.b2393 CrossRefPubMedPubMedCentral

17.

Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res. 2011;46(3):399–424. doi:https://doi.org/10.1080/00273171.2011.568786 CrossRefPubMedPubMedCentral

18.

Serrano PE, Kim D, Kim PT, et al. Effect of Pancreatic Fistula on Recurrence and Long-Term Prognosis of Periampullary Adenocarcinomas after Pancreaticoduodenectomy. Am Surg. 2016;82(12):1187-1195.PubMed

19.

Lubrano J, Bachelier P, Paye F, et al. Severe postoperative complications decrease overall and disease free survival in pancreatic ductal adenocarcinoma after pancreaticoduodenectomy. Eur J Surg Oncol. 2018;44(7):1078–1082. doi:https://doi.org/10.1016/j.ejso.2018.03.024 CrossRefPubMed

20.

Dundar HZ, Tasar P, Isik O, Kaya E. Anastomotic leaks at the pancreaticojejunostomy following pancreaticoduodenectomy in patients with pancreatic head adenocarcinoma increases the local recurrence rate. Ann Ital Chir. 2018;89:315–319.PubMed

21.

Kendrick ML, van Hilst J, Boggi U, et al. Minimally invasive pancreatoduodenectomy. HPB (Oxford). 2017;19(3):215–224. doi:https://doi.org/10.1016/j.hpb.2017.01.023 CrossRefPubMed

22.

Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc. 2012;26(9):2397–2402. doi:https://doi.org/10.1007/s00464-012-2207-6 CrossRefPubMed

23.

Bao PQ, Mazirka PO, Watkins KT. Retrospective comparison of robot-assisted minimally invasive versus open pancreaticoduodenectomy for periampullary neoplasms. J Gastrointest Surg. 2014;18(4):682–689. doi:https://doi.org/10.1007/s11605-013-2410-3 CrossRefPubMed

24.

Buchs NC, Addeo P, Bianco FM, Ayloo S, Benedetti E, Giulianotti PC. Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg. 2011;35(12):2739–2746. doi:https://doi.org/10.1007/s00268-011-1276-3 CrossRefPubMed

25.

Boggi U, Signori S, De Lio N, et al. Feasibility of robotic pancreaticoduodenectomy. Br J Surg. 2013;100(7):917–925. doi:https://doi.org/10.1002/bjs.9135 CrossRefPubMed

26.

Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010;24(7):1646–1657. doi:https://doi.org/10.1007/s00464-009-0825-4 CrossRefPubMed

27.

Kantor O, Pitt HA, Talamonti MS, et al. Minimally invasive pancreatoduodenectomy: is the incidence of clinically relevant postoperative pancreatic fistula comparable to that after open pancreatoduodenectomy? Surgery. 2018;163(3):587–593. doi:https://doi.org/10.1016/j.surg.2017.12.001 CrossRefPubMed

28.

Nassour I, Wang SC, Christie A, et al. Minimally Invasive Versus Open Pancreaticoduodenectomy: A Propensity-matched Study From a National Cohort of Patients. Ann Surg. 2018;268(1):151–157. doi:https://doi.org/10.1097/SLA.0000000000002259 CrossRefPubMed

Title: Robotic Pancreaticoduodenectomy Is Associated with Decreased Clinically Relevant Pancreatic Fistulas: a Propensity-Matched Analysis
Authors: Jianpeng Cai
Rajesh Ramanathan
Mazen S. Zenati
Amr Al Abbas
Melissa E. Hogg
Herbert J. Zeh
Amer H. Zureikat
Publication date: 01-05-2020
Publisher: Springer US
Keywords: Pancreatoduodenostomy
Pancreatoduodenostomy
Published in: Journal of Gastrointestinal Surgery / Issue 5/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04274-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Robotic Pancreaticoduodenectomy Is Associated with Decreased Clinically Relevant Pancreatic Fistulas: a Propensity-Matched Analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2020

Faculty Diversity at Academic Surgical Meetings—Opportunity for Action?

Prognostic Significance of Pre- and Post-operative Red-Cell Distribution Width in Patients with Gastric Cancer

Relapsing Acute Pancreatitis Caused by a Mucinous Cystic Neoplasm

Impact of Radial Margin Status After Esophagectomy for Adenocarcinoma

The Impact of Minimally Invasive Gastrectomy on Survival in the USA

Predicting Overall Survival in Patients with Metastatic Rectal Cancer: a Machine Learning Approach