Spleen Preservation Research Articles

Fate of Small Remnant Pancreas Tail in Splenic Hilum after Laparoscopic Spleen Preserving Distal Pancreatectomy

Introduction: Laparoscopic spleen preserving distal pancreatectomy (LSPDP) has been shown to be safe and readily feasible. However, we sometimes encounter anatomically challenging patients with the pancreas tail deep into the splenic hilum. The purpose of this study was to discuss the experience of the surgical technique leaving a deep pancreas tail of the splenic hilum in these patients. Methods: There were ten patients who underwent LSPDP with remnant pancreas tail between November 2019 and July 2021 at Samsung Medical Center, Seoul, Korea. Their short-term postoperative outcomes were analyzed retrospectively. Results: Mean operative time was 180.7 ± 18.9 min, estimated blood loss was 192.9 ± 105.8 ml, and postoperative length of stay was 6.3 ± 1.0 days. All ten lesions were in the body or tail of the pancreas and included: 4 intraductal papillary mucinous neoplasms (IPMNs), 4 neuroendocrine tumors, a chronic pancreatitis and a metastatic renal cell carcinoma. Among ten patients, pancreas tail in nine patients were left only on the splenic hilum at distal portion inside branching of the splenic vessel, and there was intraabdominal fluid collection which was naturally resolved. But other one patient with remnant pancreas tail above the hilar vessels re-admitted due to postoperative pancreatic fistula with fever, and underwent internal drainage. Conclusions: In spleen preservation, leaving small pancreas tail inside the splenic hilum would be feasible and more beneficial to the patient, rather than performing splenectomy in anatomically challenging patients.Tabled 1EP02E-00664/FPre-Op. : R/O PNETPost-Op. : Chronic pancreatitisSplenic vessel LigatedNo POPF5 days (Hosp. stay)X (Re-admission)49/MPNETPreservedBCL6X45/MIPMNLigatedBCL6X41/MPNETLigatedBCL7X56/FPNETPreservedNo5X38/MPNETLigatedBCL6X50/MIPMNLigatedGrade B8O74/MIPMNLigatedBCL10X61/MMetastatic renal cell ca.LigatedBCL7X25/FIPMNPreservedBCL7X Open table in a new tab

Comparison of Surgical Site Infection after Laparoscopic and Open Distal Pancreatectomy

Introduction: Laparoscopic surgery is expected to reduce surgical site infections (SSI) because trocar site has a small incision compared to open surgery. The purpose of this study was to investigate risk factors for SSI after laparoscopic and open distal pancreatectomy (DP). Method: A total of 159 patients who received DP from January 2002 to December 2019 were included in this study. Clinical data was collected retrospectively based on the patient's medical history. Risk factors were analyzed by t-test and logistic regression analysis. Results: Of the 159 patients, 42 patients underwent laparoscopic DP surgery. In the open surgery group of 117 patients, 13 experienced SSI (11.1%). However, there was only 1 case of SSI in the laparoscopic surgery group (2.4%) (p = 0.073). In multivariate analysis, male sex and hypertension were significant risk factors for organ space (p = 0.040, p = 0.032, respectively). Male sex and combined surgery were associated with overall complications (p = 0.039, p = 0.026, respectively). However, laparoscopic surgery, spleen preservation, and preoperative antibiotics were not a risk factor for SSI in multivariate analysis. Conclusion: Laparoscopic surgery had less SSI than open DP. However, it was not verified as a risk factor for SSI in multivariate analysis. Laparoscopic surgery is expected to have less SSI, we think that further investigation with more patients is necessary.

A PROSPECTIVE OBSERVATIONAL STUDY ON SURGICAL INDICATIONS FOR SPLENECTOMY IN A TERTIARY CARE CENTER.

Background: Spleen mediates important immunologic, storage and hematologic functions. A person can undergo a splenectomy for various causes which includes both surgical and non surgical. The recent trend being towards spleen preservation, it is necessary to critically analyse the indications for splenectomy and assess if the desired post operative outcomes are achieved by splenectomy. Materials and Methods: This prospective observational study was carried out on patients of Department of General Surgery, Mysore Medical College and Research Institute, Mysore, from august 2017 to November 2019. 45 adult subjects (both male and females) aged ≥ 18 years, who underwent elective or emergency splenectomy for various indications were studied. Results: The most common indication for splenectomy was trauma in 27 patients(60%) followed by splenic abscess(15.6%). Most of the patients underwent emergency splenectomy i.e., 25 cases(55%) . In our study the majority received blood transfusion, 15.5% developed wound infection and 2 cases(4.4%) needed reexploration due to rebleeding.

A comparison of robotic versus laparoscopic distal pancreatectomy: Propensity score matching analysis.

The aim of this study was to assess the perioperative and pathologic outcomes of robotic distal pancreatectomy compared with a laparoscopic approach. A total of 121 robotic distal pancreatectomies and 992 laparoscopic distal pancreatectomies were retrospectively evaluated, comparing the demographic, perioperative and pathologic outcomes. After 1:2 propensity score matching (PSM) with 11 demographic variables, the factors were analysed again. Following PSM, 104 robotic distal pancreatectomy patients were compared with 208 laparoscopic distal pancreatectomy patients. The operation time and proportion of spleen preservation were not different between the groups. The rates of open conversion were lower, whereas the hospital costs were higher in the robotic group. Other perioperative outcomes and pathologic factors did not differ between the groups. Although robotic distal pancreatectomy is more expensive, this operation is feasible, with a higher probability of proceeding with the planned operation and with low open conversion rate.

Surgical management of splenic abscess complicated by pleural effusion in rural setting: A case report from rural Indonesia.

Introduction and importanceSplenic abscess is a potentially life-threatening disease. Antibiotics along with surgery are the gold standard therapy. We present a case of splenic-salvaged surgical management of a large splenic abscess in a rural setting, complying with the available resources.Case presentationA 35-year old female presented to the ER with a history of left hypochondrium pain and fever for seven days. Abdominal tenderness at the left hypochondrium with an enlarged spleen was found. Laboratory tests showed severe anemia, leukocytosis, and thrombocytosis. Chest X-ray suggested pulmonary tuberculosis with minimal left pleural effusion. Ultrasound revealed a large unifocal splenic abscess. Antibiotics were administered. Simplified percutaneous drainage was performed, followed by open surgery abscess drainage. The patient showed a smooth recovery.Clinical discussionPulmonary tuberculosis finding in a patient with splenic abscess suggested the potential etiology which itself is a rare finding. Spleen preservation surgery along with antibiotics is preferable to retain immunologic functions. In the rural setting, like Indonesia, where a pig-tail catheter set is not available, a simplified abscess drainage procedure is feasible. In patients with poor conditions, laparotomy and splenectomy approaches would lead to higher mortality and morbidity rates. Chest tube insertion may not be necessary for minimal pleural effusion in a splenic abscess as it may resolve naturally along with the abscess recovery.ConclusionLarge splenic abscess can be managed by abscess drainage if the lesion is unifocal, in a view of the spleen being salvageable in patients with poor general conditions.

Solid-cystic pseudo papillary tumor of the pancreas discovered during presentation of acute appendicitis

to present a rare case of pancreatic pseudo-papillary and solid tumor in children and to make a review of the literature. Solid-pseudo-papillary tumor of the pancreas (TPPS) is infrequently case of neoplasm in children. It is low-grade malignant potential. A 15-year-old boy with a pancreatic solid pseudo papillary tumor (TPPS) is reported, discovered after acute appendicitis. ultrasound and Contrast enhanced computerized tomography (CECT) abdomen revealed acute appendicitis and pancreatic mass centered on the distal pancreas. In the first step, appendectomy was done and the exploration was completed. After few months, distal pancreatectomy with spleen preservation was done. The histopathologic report was a pancreatic solid pseudo papillary tumor without malignant cells. Clinical evolution has been satisfactory without recurrence of the tumor till 10 months of follow-up. the most common clinical presentation is abdominal mass. The treatment is surgical and Distal pancreatectomy offers an excellent prognosis.

Management of Traumatic Pancreatic Injuries: Evaluation of 7 Years of Experience at a Single Regional Trauma Center

Purpose Traumatic pancreatic injuries are rare, but their diagnosis and management are challenging. The aim of this study was to evaluate and report our experiences with the management of pancreatic injuries. Methods We identified all adult patients (age >15) with pancreatic injuries from our trauma registry over a 7-year period. Data related to patients’ demographics, diagnoses, operative information, complications, and hospital course were abstracted from the registry and medical records. Results A total of 45 patients were evaluated. Most patients had blunt trauma (89%) and 21 patients (47%) had pancreatic injuries of grade 3 or higher. Twenty-eight patients (62%) underwent laparotomy and 17 (38%) received nonoperative management (NOM). The overall in-hospital mortality rate was 24% (n=11), and only one patient died after NOM (due to a severe traumatic brain injury). Twenty-two patients (79%) underwent emergency laparotomy and six (21%) underwent delayed laparotomy. A drainage procedure was performed in 12 patients (43%), and pancreatectomy was performed in 16 patients (57%) (distal pancreatectomy [DP], n=8; DP with spleen preservation, n=5; pancreaticoduodenectomy, n=2; total pancreatectomy, n=1). Fourteen (31%) pancreas-specific complications occurred, and all complications were successfully managed without surgery. Solid organ injuries (n=14) were the most common type of associated abdominal injury (Abbreviated Injury Scale ≥3). Conclusions For traumatic pancreatic injuries, an appropriate treatment method should be considered after evaluation of the accompanying injury and the patient’s hemodynamic status. NOM can be performed without mortality in appropriately selected cases.

Rare Pseudopapillary Neoplasm of the Pancreas: A 10-Year Experience

Introduction The solid pseudopapillary epithelial neoplasm (SPN) is a rare form of pancreatic neoplasm with an incidence of 2-3% of all pancreatic tumours. The recent increase in incidence is attributed to the increasing use of imaging techniques for nonspecific abdominal complaints. We report our institutional experience in the management of this tumour over the last decade. Method We retrospectively analyzed from a prospectively maintained database of patients from January 2011 to December 2020 who were operated upon for SPN. All the patients were followed till date. Results Of 479 patients operated on for various types of pancreatic tumours during this period, 15 (3.1%) had SPN. The mean age of presentation was 28 years with a female preponderance (12/15, 80%). The most common location was the body and tail of the pancreas (66%), and the mean size was 6.4 cm (2–15 cm). The tumour extent was defined as ‘borderline resectable' in 20% of cases. Distal pancreatectomy was done in 11 patients with spleen preservation in 3. R0, R1, and R2 resection were done in 12, 2, and 1 patient(s), respectively. The operative mortality was 6.7%. All the patients are doing well on follow-up. Conclusion SPN is a low-grade malignant tumour with a strong female predilection. Clinical manifestations have no specificity, imaging examination only contributes tumour location, and the final diagnosis rests on pathology. Surgery is the main modality of treatment and carries a good prognosis.

The use of selective splenic vascular control in laparoscopic splenic vessels and spleen preservation distal pancreatectomy.

In the process of laparoscopic splenic vessels and spleen preservation distal pancreatectomy (LsvSPDP), because the splenic blood vessels have many small branches, how to safely separate the splenic blood vessels from the pancreas has always been the focus and difficulty of this operation. Many cases were switched to laparotomy, or the Warshaw method due to the inability to control bleeding during the separation of the splenic blood vessels. Therefore, we tried to use the selective splenic vascular control method when separating the splenic blood vessels to observe its effect on the conditions of the surgical patients during and after the operation. We retrospectively collected 35 cases of LsvSPDP conducted in our center from September 2015 to December 2020, including 5 males and 30 females. Considering the influence of the surgical learning curve, the cases were divided into three groups. Finally, through statistics of its intraoperative and postoperative conditions, the effectiveness of selective splenic vascular control method can be judged. Patients in Group 2 and 3 showed significantly less blood loss (172.5 and 134.44 mL, respectively) compared to patients in Group 1 (541.43 mL; P=0.01). However, the amount of blood loss was not significantly different between Group 2 and 3. The amount of bleeding was significantly reduced by splenic blood vessel control technology. And it can improve the success rate of spleen preservation, preserve the success rate of splenic blood vessels, and reduce intraoperative bleeding.

The clinicopathologic and operative characteristics of patients with small nonfunctioning pancreatic neuroendocrine tumors.

Incidentally detected, small nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are increasingly diagnosed on imaging modalities. This retrospective investigation evaluated the clinicopathologic characteristics and perioperative and oncologic outcomes in patients with small NF-PNETs undergoing curative resection. The medical records of 444 patients who underwent pancreatic resection for NF-PNETs at a single, large-volume institution between January 2000 and December 2018 were retrospectively reviewed. Patients were divided into those with small (≤2cm) and large (>2cm) tumors based on the largest tumor diameter on preoperative computed tomography (CT). Outcomes were also evaluated in subgroups of patients with small NF-PNET who did and did not undergo lymphadenectomy. Of the 444 patients with NF-PNETs, 195 (43.9%) had small (≤2cm) and 249 (56.1%) had large (>2cm) NF-PNETs. The rate of parenchyma-preserving surgery (14.4% vs. 7.2%, p=0.014) and the ratio of spleen preservation for left-sided pancreatectomy (65.6% vs. 38.3%, p < 0.001) were higher in the small NF-PNET group. Size on CT >2cm (p < 0.001, hazard ratio [HR]: 5.836, 95% confidence interval [CI]: 2.474-13.769), presence of perineural invasion (p < 0.001, HR: 3.025, 95% CI: 1.640-5.577), World Health Organization (WHO) Grade 2 (p=0.007, HR: 2.861, 95% CI: 1.325-6.176), and WHO Grade 3 (p < 0.001, HR: 11.537, 95% CI: 5.282-25.199) were independent predictors of disease-free survival (DFS). DFS did not differ significantly in patients with small NF-PNETs who did and did not undergo lymphadenectomy (p=0.886). Assessment of long-term oncologic outcomes suggests that surgical resection may cure small NF-PNETs. Minimally invasive surgery and organ-preserving surgery are acceptable treatment options for select patients with small NF-PNETs. The effect on survival outcomes of lymph node dissection for small NF-PNETs remains unclear.

Risk factors for deep incisional and organ space surgical site infection after distal pancreatectomy

Surgical site infection (SSI) is an infection occurs after surgery in the part of the body where the surgery took place within 30 days and a significant portion of healthcare-associated infections. Distal pancreatectomy (DP) is a major surgery associated with a relatively high incidence of SSI. The aim of this study is to investigate risk factors of SSI after distal pancreatectomy. In total, 159 patients who underwent DP from January 2002 to December 2019 were identified and included in this study. We retrospectively collected clinical data based on the medical records of the patients. The risk factors were analyzed by logistic regression analysis. A total of 14 patients (8.8%) developed SSI after DP. Four patient (2.5%) experienced deep incisional SSI and 10 patient (6.3%) had organ space SSI. Male sex was associated with SSI. Hypertension and combined surgery were associated with organ space SSI in univariate analysis. Male sex and hypertension were significant risk factor of organ space SSI in multivariate analysis (p = 0.040, p = 0.032, respectively). Male sex and combined surgery were associated with overall complication (p = 0.039, p = 0.026, respectively). However, age, body mass index, diabetes, diagnosis, type of antibiotics administered, laparoscopic surgery, and spleen preservation were not associated with SSI. Male sex, hypertension, and other concomitant organ resections were statistically associated with SSI. The type of prophylactic antibiotics used was not related to SSI. Organ space SSI is associated with significant complications and the effort to reduce SSI is important.

Splenic preservation versus splenectomy during laparoscopic distal pancreatectomy for benign and low-grade malignant pancreatic tumor: A propensity score matching analysis

Previous studies showed the advantages of spleen preservation during laparoscopic distal pancreatectomy (LDP) such as preventing overwhelming postsplenectomy infection, and early infectious complications, maintaining immune surveillance, less postoperative pancreatic fistula, less postpancreatectomy diabetes, and less gastric ileus. However, there were limitations of these results such as heterogenous population, and small number of patients. This study was aimed to compare clinical outcomes of patients with LDP with splenectomy (LDPS) and laparoscopic spleen preserving distal pancreatectomy (LSDP) using propensity score matching analysis from data of multi centers in Korea and Japan. The patients were identified who underwent LDPS and LSDP in Korea and Japan. Perioperative outcomes including postoperative infectious complication were compared between LDPS and LSDP before and after PSM. Matching variables were used such as nation, age, sex, BMI, ASA scores, underlying disease, previous abdominal surgery, preoperative pancreatitis, malignant disease and tumor locations. LDPS and LSDP were classified in 1,728 (39.6%), and 2,635 (60.4%), respectively. In the mean age and body mass index were 56.3 and 23.4. And 1,166 (26.7%) patients underwent previous abdominal surgery and tumor was located in body and tail in 2,041 (46.8%) and 2,290 (52.5%), respectively. Pancreas was transected at pancreas neck and tail level in 1,794 (41.1%) and 2,521 (57.8%), respectively. Splenic vessels were preserved in 1,244 (28.5%) of 2,635 patients with LSDP. Two hundred patients (4.6%) experienced conversion to open during surgery. Of patients, 1,303 (29.9%) patients experienced postoperative complications. Clinically related postoperative pancreatic fistula (CR-POPF) and infectious complication rates were 693 (15.3%) and 760 (17.4%) patients, respectively. After PSM, 1,594 patients were selected in each group. The patients with LSDP showed comparable overall complication (35.7 % vs. 38.4 %, p = 0.094), however LSDP group showed lower infectious complications (15.2 % vs. 19.1 %, p = 0.036), CR-POPF (13.7 % vs. 18.7 %, p < 0.001), infected POPF (5.7 % vs. 9.7 %, p < 0.001), complicated fluid collection (0.94% vs. 2.82%, p < 0.001) compared with the patients with LDP. The results of this study showed that LSDP was related with lower infectious complication rate including lower infected POPF, and lower complicated fluid collection compared with LDPS, and this result is helpful to decide splenic preservation in patients who needs LDP for pancreatic body or tail lesions.

Minimal invasive distal pancreatectomy: Chronologic changes in the trends and clinical outcomes through an 15-year single center experience with 2,212 patients

Based on the development and expansion of treatment strategies since the 2000s, we identify the chronologic changes of the clinical and postoperative outcomes of minimal invasive distal pancreatectomy (MIDP) for left-sided pancreatic tumor. Between 2005 and 2019, 2,212 patients underwent planned MIDP. The chronologic change in MIDP was analyzed according to procedure (open distal pancreatectomy [OPD] vs. MIDP), age, spleen preserving, and maligancy. In addition, the difference in clinical and postoperative outcomes was identified by dividing the periods at 5-year intervals, and prognostic factors of open converison and severe postoperative complication were analyzed. MIDP has been increasing steadily over 15 years when comparing ODP (from 10.8% to 84.9%). Benign disease has a plateau pattern with a proportion of around 90% from 2010, but in pancreatic ductal adenocarcinoma (PDAC), the proportion of MIDP from 5.6% to 68.4% has been steadily increasing. In the second half of 15 years, compared to the first five years, PDAC increased from 8.3% to 32.8%, and above all, the proportion of RAMPS increased significantly. The open conversion rate was 3.5%, and the risk factors for open conversion in multivariate logistic regression analysis was malignancy, extended pancreatectomy, and site of tumor lesion (body). Also, the poor prognostic factor of severe complication was malignancy, extended pancreatectomy, and ASA classification ≥ 3. In benign disease, MIDP is considered a standard procedure. However, MIDP at PDAC still has a technical and oncological challenge. We need high quality randomized controlled trials for acceptable of MIDP in PDAC.

Preclinical Assessment of Ursolic Acid Loaded into Nanostructured Lipid Carriers in Experimental Visceral Leishmaniasis.

Ursolic acid, a triterpene produced by plants, displayed leishmanicidal activity in vitro and in vivo; however, the low solubility of this triterpene limits its efficacy. To increase the activity of ursolic acid (UA), this triterpene was entrapped in nanostructured lipid carriers (UA-NLC), physical-chemical parameters were estimated, the toxicity was assayed in healthy golden hamsters, and the efficacy of UA-NLC was studied in experimental visceral leishmanisis. UA-NLC exhibited a spherical shape with a smooth surface with a size of 266 nm. UA-NLC displayed low polydispersity (PDI = 0.18) and good colloidal stability (−29.26 mV). Hamsters treated with UA-NLC did not present morphological changes in visceral organs, and the levels of AST, ALT, urea and creatinine were normal. Animals infected with Leishmania (Leishmania) infantum and treated with UA-NLC showed lower parasitism than the infected controls, animals treated with UA or Amphotericin B (AmB). The therapeutic activity of UA-NLC was associated with the increase in a protective immune response, and it was associated with a high degree of spleen and liver preservation, and the normalization of hepatic and renal functions. These data indicate that the use of lipid nanoparticles as UA carriers can be an interesting strategy for the treatment of leishmaniasis.

Native Spleen Preservation During Visceral Transplantation Inhibits Graft-Versus-Host-Disease Development: Clinical and Experimental Study.

We aimed to assess whether native spleen preservation during visceral transplantation (VT) affects graft-versus-host-disease (GVHD) incidence. GVHD is one of the most severe and frequently lethal hematological complications after VT procedures. Because there is no specific treatment for GVHD, it is imperative to develop a strategy to reduce donor lymphocyte engraftment and proliferation. Our study included both clinical and experimental data. A total of 108 patients were divided into 3 groups: a native spleen preservation group, a native spleen removal with no donor spleen group, and a donor spleen included (allogeneic spleen) group. We also used an allogeneic VT rat model, in which recipients were divided into 2 groups: a native spleen preservation (+SP) group and a native spleen removal (-S) group. Skin rash appearance, histopathological changes, chimerism, and spleen effects on circulating allogeneic T-cells were assessed. The patients with native spleen preservation showed a lower rate of GVHD ( P <.001) and better survival ( P <.05) than those in the other groups. Skin and histological signs of GVHD were lower in the rats in the +SP group ( P <.05). The donor T-cell frequency in the bloodstream and skin was also significantly reduced when the native spleen was preserved ( P <.01 and P <.0001, respectively). The clinical and experimental data indicate that recipient spleen preservation protects against GVHD after VT, and donor cell clearance from the bloodstream by spleen macrophages could be the underlying mechanism. Therefore, spleen preservation should be considered in VT procedures, whenever possible.

Robotic versus Laparoscopic Surgery for Spleen-Preserving Distal Pancreatectomies: Systematic Review and Meta-Analysis.

Background: When oncologically feasible, avoiding unnecessary splenectomies prevents patients who are undergoing distal pancreatectomy (DP) from facing significant thromboembolic and infective risks. Methods: A systematic search of MEDLINE, Embase, and Web Of Science identified 11 studies reporting outcomes of 323 patients undergoing intended spleen-preserving minimally invasive robotic DP (SP-RADP) and 362 laparoscopic DP (SP-LADP) in order to compare the spleen preservation rates of the two techniques. The risk of bias was evaluated according to the Newcastle–Ottawa Scale. Results: SP-RADP showed superior results over the laparoscopic approach, with an inferior spleen preservation failure risk difference (RD) of 0.24 (95% CI 0.15, 0.33), reduced open conversion rate (RD of −0.05 (95% CI −0.09, −0.01)), reduced blood loss (mean difference of −138 mL (95% CI −205, −71)), and mean difference in hospital length of stay of −1.5 days (95% CI −2.8, −0.2), with similar operative time, clinically relevant postoperative pancreatic fistula (ISGPS grade B/C), and Clavien–Dindo grade ≥3 postoperative complications. Conclusion: Both SP-RADP and SP-LADP proved to be safe and effective procedures, with minimal perioperative mortality and low postoperative morbidity. The robotic approach proved to be superior to the laparoscopic approach in terms of spleen preservation rate, intraoperative blood loss, and hospital length of stay.

Robotic versus open total pancreatectomy: a retrospective cohort study.

Robotic total pancreatectomy (RTP), although considered safe and feasible, has rarely been reported. This study aimed to evaluate whether RTP has advantages over open TP (OTP). Demographics and perioperative outcomes among patients who underwent RTP (n=14) versus OTP (n=15) between May 2015 and September 2020 were retrospectively analyzed. RTP reduced the operative time (307.2 vs. 382.0 min, p=0.01) and estimated blood loss (EBL) (200 vs. 700 ml, p=0.002) compared to those of OTP. The patients in the RTP group got out of their beds and stood, received their first liquid, and took oral diets earlier (2.0 vs. 3.0 days, p=0.002; 2.0 vs. 4.0 days, p=0.009; 3.0 vs. 5.0 days, p=0.006) and experienced a shorter postoperative hospital stay (PHS) (9.0 vs. 12.0 days, p=0.03). There were no significant differences in the rates of spleen preservation, splenic vessel preservation, bile leakage, delayed gastric emptying, morbidity, or the number of lymph nodes harvest between the two groups. This study demonstrates that RTP is safe and feasible in selected patients with different indications in experienced robotic center. RTP was associated with a shorter operative time, lower EBL, and shorter PHS than OTP.

A retrospective comparative study of robotic distal pancreatectomy with or without splenic vessel and spleen preservation

BackgroundRobotic distal pancreatectomy has been accepted to be safe and effective for pancreatic tail lesion. Whether spleen preservation by preserving the splenic vessels with robot assistance is feasible and beneficial remains controversial. Here we would like to compare the operative outcomes of robotic distal pancreatectomy and splenectomy (DPS) with robotic spleen preserving distal pancreatectomy by means of splenic vessel preservation (SVP). MethodsBetween March 2011 and September 2019, 56 consecutive patients undergoing robotic distal pancreatectomy were identified, with 28 patients in each group. Patient demographics, histopathology findings and operative outcomes were prospectively collected and compared between the two groups. A subgroup analysis was made after excluding malignant and pancreatic lesions >6 cm in the DPS group. ResultsThe two groups had similar conversion rate, blood loss, morbidity and pancreatic fistula rate. There was no operative mortality. The SVP group had shorter median operative time (245 vs 303.5 min, P = 0.019) and shorter median hospital stay (5 vs 6 days, P = 0.019) than the DPS group. However, all malignant lesions occurred in the DPS group and lesion size in DPS group was significantly larger. After matching, there were 28 SVP and 15 DPS. The histopathology findings and lesion size became comparable. The SVP group still had shorter operative time (245 vs 290 min, P = 0.022) and shorter hospital stay (5 vs 7 days, P = 0.014) than the DPS group. ConclusionApart from avoiding risk of overwhelming postsplenectomy sepsis, robotic SVP had additional advantage of shorter operative time and shorter hospital stay than robotic DPS.

Updated Meta-analysis of Minimally Invasive Versus Open Surgery for Pancreatic Neuroendocrine Neoplasms.

The aim of this study was to compare the short-term and long-term outcomes of minimally invasive surgery (MIS) with those of open pancreas surgery (OPS) for the treatment of pancreatic neuroendocrine neoplasms (pNENs). Studies reporting the effects of MIS and OPS for pNENs, published on PubMed, Embase, and Cochrane Library before May 2020 were reviewed. Seventeen cohort studies with a total of 1853 patients were eligible for analysis, including 655 patients in the MIS group and 1198 patients in the OPS group. The estimated blood loss, postoperative hospitalization time, overall complications, severe complications, spleen preservation, mortality, and recurrence in the MIS group were lower than those in the OPS group. The R0 rate, 3-year overall survival (OS), and 5-year OS in the MIS group were higher than those in the OPS group. There were no significant differences in operative time, postoperative pancreatic fistula, clinical postoperative pancreatic fistula, postoperative bleeding, reoperation, readmission, and 1-year OS. Minimally invasive surgery can reach lower recurrence rate, higher long-term survival rate, and better outcomes in terms of estimated blood loss, postoperative hospitalization time, R0 rate, mortality, overall complications, and severe complications for pNENs. More high quality studies need to be conducted for further verification.

Minimally invasive distal pancreatectomy: a case-matched cost-analysis between robot-assisted surgery and direct manual laparoscopy

BackgroundFew studies have reported a structured cost analysis of robotic distal pancreatectomy (RDP), and none have compared the relative costs between the robotic-assisted surgery (RAS) and the direct manual laparoscopy (DML) in this setting. The aim of the present study is to address this issue by comparing surgical outcomes and costs of RDP and laparoscopic distal pancreatectomies (LDP).MethodsEighty-eight RDP and 47 LDP performed between January 2008 and January 2020 were retrospectively analyzed. Three comparable groups of 35 patients each (Si-RDP-group, Xi-RDP group, LDP-group) were obtained matching 1:1 the RDP-groups with the LDP-group. Overall costs, including overall variable costs (OVC) and fixed costs were compared using generalized linear regression model adjusting for covariates.ResultsThe conversion rate was significantly lower in the Si-RDP-group and Xi-RDP-group: 2.9% and 0%, respectively, versus 14.3% in the LDP-group (p = 0.045). Although not statistically significant, the mean operative time was lower in Xi-RDP-group: 226 min versus 262 min for Si-RDP-group and 247 min for LDP-group. The overall post-operative complications rate and the length of hospital stay (LOS) were not significantly different between the three groups. In LDP-group, the LOS of converted cases was significantly longer: 15.6 versus 9.8 days (p = 0.039). Overall costs of LDP-group were significantly lower than RDP-groups, (p < 0.001). At multivariate analysis OVC resulted no longer statistically significantly different between LDP-group and Xi-RDP-group (p = 0.099), and between LDP-group and the RDP-groups when the spleen preservation was indicated (p = 0.115 and p = 0.261 for Si-RDP-group and Xi-RDP-group, respectively).ConclusionsRAS is more expensive than DML for DP because of higher acquisition and maintenance costs. The flattening of these differences considering only the variable costs, in a high-volume multidisciplinary center for RAS, suggests a possible optimization of the costs in this setting. RAS might be particularly indicated for minimally invasive DP when the spleen preservation is scheduled.