Abstract
Background Laparoscopic distal pancreatectomy (LDP) has become a routine procedure in pancreatic surgery. Although robotic distal pancreatectomy (RDP) has not been popularized yet, it has shown new advantages in some aspects, and exploring its learning curve is of great significance for guiding clinical practice. Methods 149 patients who received RDP and LDP in our surgical team were enrolled in this retrospective study. Patients were divided into two groups including LDP group and RDP group. The perioperative outcomes, histopathologic results, long-term postoperative complications, and economic cost were collected and compared between the two groups. The cumulative summation (CUSUM) analysis was used to explore the learning curve of RDP. Results The hospital stay, postoperative first exhaust time, and first feeding time in the RDP group were better than those in the LDP group (P < 0.05). The rate of spleen preservation in patients with benign and low-grade tumors in the RDP group was significantly higher than that of the LDP group (P=0.002), though the cost of operation and hospitalization was significantly higher (P < 0.001). The learning curve of RDP in our center declined significantly with completing 32 cases. The average operation time, the hospital stay, and the time of gastrointestinal recovery were shorter after the learning curve node than before. Conclusion RDP provides better postoperative recovery and is not difficult to replicate, but the high cost was still a major disadvantage of RDP.
Highlights
Comparative studies on the efficacy of robotic distal pancreatectomy (RDP) and Laparoscopic distal pancreatectomy (LDP) are rare, especially the follow-up study on the long-term complications caused by partial pancreatectomy and splenectomy
We reviewed the clinical data of patients who underwent minimally invasive distal pancreatectomy from 2013 to 2019 at the Affiliated Hospital of Qingdao University (Figure 1), including demographic and clinical characteristics, pathological conditions, intraoperative conditions, and short- and long-term postoperative complications
Laparoscopic distal pancreatectomy was performed through five ports, with the patient in the supine position and a pad under the left side
Summary
Invasive technology has rapidly developed in recent decades. Laparoscopy has gradually become a routine method in the treatment of kidney, colon, adrenal gland, prostate, and other tumors [1]. Since approximately 50% of pancreatic tumors locate in the body and tail of the pancreas, the main surgical method for such tumors is distal pancreatectomy. Since the first laparoscopic distal pancreatectomy (LDP) was performed more than 20 years ago, it has been recognized as a safe and effective treatment for pancreatic body and tail tumors [5]. There is still controversy about the choice of surgical methods for pancreatic malignant tumors, most surgeons still choose minimally invasive surgery for patients with benign and lowgrade malignant tumors of the pancreas for they have a longer postoperative survival time. E rate of spleen preservation in patients with benign and low-grade tumors in the RDP group was significantly higher than that of the LDP group (P 0.002), though the cost of operation and hospitalization was significantly higher (P < 0.001). RDP provides better postoperative recovery and is not difficult to replicate, but the high cost was still a major disadvantage of RDP
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