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01-12-2016 | REVIEW ARTICLE

Robotic pancreatoduodenectomy with vascular resection

Authors: Emanuele F. Kauffmann, Niccolò Napoli, Francesca Menonna, Fabio Vistoli, Gabriella Amorese, Daniela Campani, Luca Emanuele Pollina, Niccola Funel, Carla Cappelli, Davide Caramella, Ugo Boggi

Published in: Langenbeck's Archives of Surgery | Issue 8/2016

Abstract

Purpose

This study aims to define the current status of robotic pancreatoduodenectomy (RPD) with resection and reconstruction of the superior mesenteric/portal vein (RPD-SMV/PV).

Methods

Our experience on RPD, including RPD-SMV/PV, is presented along with a description of the surgical technique and a systematic review of the literature on RPD-SMV/PV.

Results

We have performed 116 RPD and 14 RPD-SMV/PV. Seven additional cases of RPD-SMV/PV were identified in the literature. In our experience, RPD and RPD-SMV/PV were similar in all baseline variables, but lower mean body mass and higher prevalence of pancreatic cancer in RPD-SMV/PV. Regarding the type of vein resection, there were one type 2 (7.1 %), five type 3 (35.7 %) and eight type 4 (57.2 %) resections. As compared to RPD, RPD-SMV/PV required longer operative time, had higher median estimated blood loss, and blood transfusions were required more frequently. Incidence and severity of post-operative complications were not increased in RPD-SMV/PV, but post-pancreatectomy hemorrhage occurred more frequently after this procedure. In pancreatic cancer, RPD-SMV/PV was associated with a higher mean number of examined lymph nodes (60.0 ± 13.9 vs 44.6 ± 11.0; p = 0.02) and with the same rate of microscopic margin positivity (25.0 % vs 26.1 %). Mean length or resected vein was 23.1 ± 8.08 mm. Actual tumour infiltration was discovered in ten patients (71.4 %), reaching the adventitia in four patients (40.0 %), the media in two patients (20.0 %), and the intima in four patients (40.0 %). Literature review identified seven additional cases, all reported to have successful outcome.

Conclusions

RPD-SMV/PV is feasible in carefully selected patients. The generalization of these results remains to be demonstrated.

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Title: Robotic pancreatoduodenectomy with vascular resection
Authors: Emanuele F. Kauffmann
Niccolò Napoli
Francesca Menonna
Fabio Vistoli
Gabriella Amorese
Daniela Campani
Luca Emanuele Pollina
Niccola Funel
Carla Cappelli
Davide Caramella
Ugo Boggi
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1499-8

At a glance: The STEP trials

Springer Medicine

Robotic pancreatoduodenectomy with vascular resection

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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