Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

Yuanchi Weng,Baiyong Shen,Xiaxing Deng,Yusheng Shi,Chenghong Peng,Yu Jiang,Jiabin Jin,Zhen Huo

doi:10.1007/s00464-020-07639-9

Abstract

BackgroundThis study aimed to compare the short-term outcomes of open and robotic-assisted distal pancreatectomy (ODP and RDP) for benign and low-grade malignant tumors.MethodsThe patients who underwent RDP and ODP for benign or low-grade malignant pancreatic tumors at our center were included. After PSM at a 1:1 ratio, the perioperative variations in the two cohorts were compared.ResultsAfter 1:1 PSM, 219 cases of RDP and ODP were recorded. The RDP cohort showed advantages in the operative duration [120 (90–150) min vs 175 (130–210) min, P < 0.001], estimated blood loss [50 (30–175) ml vs 200 (100–300) ml, P < 0.001], spleen preservation rate (63.5% vs 26.5%, P < 0.001), infection rate (4.6% vs 12.3%, P = 0.006), and gastrointestinal function recovery [3 (2–4) vs. 3 (3–5), P = 0.019]. There were no significant differences in postoperative pancreatic fistula, postoperative hemorrhage, and delayed gastric emptying. Multivariate analysis showed that RDP (HR 0.24; 95% CI 0.16–0.36, P < 0.001), age (HR 1.02; 95% CI 1.00–1.03, P = 0.033), tumor size (HR 1.28; 95% CI 1.17–1.40, P < 0.001), pathological inflammatory neoplasm type (HR 5.12; 95% CI 2.22–11.81, P < 0.001), and estimated blood loss (HR 1.003; 95% CI 1.001–1.004, P < 0.001) were independent predictors of spleen preservation; RDP (HR 0.27; 95% CI 0.17–0.43, P < 0.001), age (HR 1.02; 95% CI 1.00–1.03, P = 0.022), elevated CA 19–9 level (HR 2.55; 95% CI 1.02–6.39, P = 0.046), tumor size (HR 1.44; 95% CI 1.29–1.61, P < 0.001), pathological inflammatory neoplasm type (HR 4.48; 95% CI 1.69–11.85, P = 0.003), and estimated blood loss (HR 1.003; 95% CI 1.001–1.004, P < 0.001) were independent predictors of spleen preservation with the Kimura technique.ConclusionRDP has advantages in the operative time, blood loss, spleen preservation, infection rate, and gastrointestinal function recovery over ODP in treating benign and low-grade malignant pancreatic tumors. The robotic-assisted approach was an independent predictor of spleen preservation and use of the Kimura technique.

Highlights

This study aimed to compare the short-term outcomes of open and robotic-assisted distal pancreatectomy (ODP and Robotic-assisted distal pancreatectomy (RDP)) for benign and low-grade malignant tumors
A total of 766 patients were discussed by the multidisciplinary team (MDT) and regarded as candidates with benign or low-grade malignant pancreatic tumor patients for spleen-preserving surgery, and these patients underwent DP on an intention-to-treat basis performed by the same surgical team
Eighty-seven cases were excluded from the final analyzed database for different reasons: (1) intraoperative cryosection pathological examination findings with a malignant component (N = 29); (2) metastatic disease, including all pancreatic neuroendocrine tumors (PNETs) cases with distant metastasis (N = 12); (3) intraoperative decision to convert to enucleation (EN) or middle pancreatectomy (MP) (N = 29); and (4) history of Whipple or middle pancreatectomy (N = 17)

Summary

Introduction

This study aimed to compare the short-term outcomes of open and robotic-assisted distal pancreatectomy (ODP and RDP) for benign and low-grade malignant tumors. The RDP cohort showed advantages in the operative duration [120 (90–150) min vs 175 (130–210) min, P < 0.001], estimated blood loss [50 (30–175) ml vs 200 (100–300) ml, P < 0.001], spleen preservation rate (63.5% vs 26.5%, P < 0.001), infection rate (4.6% vs 12.3%, P = 0.006), and gastrointestinal function recovery [3 (2–4) vs 3 (3–5), P = 0.019]. Conclusion RDP has advantages in the operative time, blood loss, spleen preservation, infection rate, and gastrointestinal function recovery over ODP in treating benign and low-grade malignant pancreatic tumors. For benign and low-grade malignant tumors in the pancreatic body/tail, LDP has already been proven to have a better postoperative effect than open distal pancreatectomy (ODP). The surgical treatment of benign and low-grade malignant tumors in the pancreatic body/tail always has the potential for spleen-preserving distal pancreatectomy (SPDP). The KT has a lower risk of splenic infarction and gastric varices, which could occur with the WT [13,14,15]

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