Abstract
BackgroundThe most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive surgery has been increasingly used in pancreatectomy. Initial results in robotic distal pancreatectomy (RDP) have been encouraging. Nonetheless, data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare. The aim of this study was to compare the safety and efficacy of RDP and LDP for PNETs.MethodsFrom September 2010 to January 2017, operative parameters and perioperative outcomes in an initial experience with 43 consecutive patients undergoing RDP were collected and compared with those in 31 patients undergoing LDP.ResultsPatients undergoing RDP and LDP demonstrated equivalent age, sex, ASA score, tumor location and tumor size. Operating time, length of resected pancreas, postoperative length of hospital stay and rates of conversion to open, pancreatic fistula, transfusion and reoperation were not statistically different. Patients in the RDP group were associated with significantly higher overall (79.1 vs. 48.4 %, P = 0.006) and Kimura spleen preservation rates (72.1 vs. 16.1%, P < 0.001) and had reduced risk of excessive blood loss (50 vs. 200mL, P < 0.001). Oncological outcomes in this series were superior for the RDP group with more lymph node harvest for G2 and G3 PNETs (3.5 vs. 2, P = 0.034).ConclusionsBoth RDP and LDP are efficacious and safe methods in treating PNETs located in the body or tail of pancreas. Robotic approach offers advantages with less intraoperative blood loss, higher spleen preservation rate and more lymph node harvest. It may be sensible to choose RDP for patients who fit indications for scheduled spleen preservation.
Highlights
Pancreatic neuroendocrine tumors (PNETs), as the name implies, are a rare group of neoplasms that originate from the endocrine portion of the pancreas, which have an incidence of 2-3 per 100,000 individuals per year, and constitute only about 1% to 2% of all pancreatic neoplasms [1,2]
Invasive surgery might be a promising treatment for insulinoma or NF-pancreatic neuroendocrine tumors (PNETs), with concrete proof in the literature supporting better outcomes of the laparoscopic approach compared with open surgery [1517]
The study population comprised a cohort of 74 consecutive patients with PNETs who underwent minimally invasive approach of distal pancreatectomy at the Department of Hepato-bilio-pancreatic Surgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, a multidisciplinary, academic tertiary care facility and the largest pancreatic surgery center in mainland China with an annual case volume of more than 500 pancreatic surgeries between September 2010 to January 2017
Summary
Pancreatic neuroendocrine tumors (PNETs), as the name implies, are a rare group of neoplasms that originate from the endocrine portion of the pancreas, which have an incidence of 2-3 per 100,000 individuals per year, and constitute only about 1% to 2% of all pancreatic neoplasms [1,2]. In 1996, Cuschieri performed the world’s first laparoscopic distal pancreatectomy (LDP) [8]. Invasive surgery might be a promising treatment for insulinoma or NF-PNETs, with concrete proof in the literature supporting better outcomes of the laparoscopic approach compared with open surgery [1517]. The first case of robotic distal pancreatectomy (RDP) was reported in 2002 [18], ushering in a new era in minimally invasive pancreatic surgery. As compared with LDP, high dexterity and clear vision of RDP would produce uniformly superior results in treating PNETs. a retrospective analysis was performed. The most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare.
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