The Safety and Feasibility of Robot-Assisted Pancreatic Surgery at a High-Volume Center: A Nine-Year Retrospective Single-Center Analysis of 1396 Patients

Abstract

Objective: We aimed to share our experience with 1396 cases of robot-assisted pancreatic surgery (RAPS) over nine years. Methods:The medical records of 1396 patients who underwent RAPS between May 2010 and December 2018 at Shanghai Ruijin Hospital were retrospectively analyzed. Operative outcomes, including the operative duration, estimated blood loss (EBL), and incidence of morbidities, especially postoperative pancreatic fistula (POPF), are discussed. We also recorded and illustrate our progress along the learning curve for RAPS in this large cohort. Results: During the study period, 1396 patients underwent RAPS at our center. Among them, 450 patients underwent robot-assisted pancreaticoduodenectomy (RPD), 605 patients underwent robot-assisted distal pancreatectomy (RDP), 144 patients underwent robot-assisted middle pancreatectomy (RMP), 119 patients underwent robot-assisted enucleation (REn), 40 patients underwent robot-assisted duodenum-preserving pancreatic head resection (R-DPPHR), 12 patients underwent robot-assisted total pancreatectomy (R-TP) and 26 patients underwent other types of surgery with a robot-assisted platform. A total of 442 patients (31.7%) suffered malignant tumors, while 357 (25.6%) patients had pancreatic ductal adenocarcinoma (PDAC). The mean operative duration was 195.3±107.4 min. The mean EBL was 197.5±107.4 ml. There were a total of 13 cases (0.9%) of conversion to open surgery due to adhesion and vascular invasion by the tumor. The total incidence rate of complications was 39.1% (546/1396). The incidence rate of clinically related (CR)-POPF of the total cohort was 16.5% (230 patients). The mean postoperative length of hospital stay (LOS) of the total cohort was 20.0±12.9 days. Conclusions: To the best of our knowledge, this is the largest sample size of RAPS cases ever reported. In conclusion, for benign and low-grade malignant pancreatic tumors, minimally invasive pancreatic surgery is safe and feasible and might be a good choice. Operative outcomes improve with accumulated experience. Further prospective analyses of RAPS should be designed to verify the advantages of RAPS. Funding Statement: The study was funded by National Natural Science Foundation of China (NSFC) directly to Baiyong Shen. Serial number: 81871906. It was also sponsored bu the Interdisciplinary Program of Shanghai Jiao Tong University directly to Jiabin Jin. Serial number: YG2019QNB26. Declaration of Interests: All the authors, Dr Yusheng Shi, Dr Jiabin Jin, Dr Junjie Xie, Dr Yuanchi Weng, Dr Mengmin Chen, Dr Kai Qin, Dr Hao Chen, Dr Xiaxing Deng, Dr Baiyong Shen and Dr Chenghong Peng have no conflicts or financial ties to disclose. Ethics Approval Statement: This retrospective study was approved by the institutional review board of Shanghai Ruijin Hospital. Every patient provided written informed consent to undergo the operation and for the use of the data we collected before and after the surgery.