Skip to main content

Advertisement

SpringerLink
Log in

Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Robot-assisted laparoscopic pancreaticoduodenectomy is a novel minimally invasive surgery technique, and its effectiveness and safety remain unknown in patients with borderline malignant or malignant diseases. This study aimed to prospectively evaluate the effectiveness and safety of RLPD versus open PD (OPD).

Methods

Between January 2010 and December 2013, 180 eligible patients were prospectively hospitalized for elective RLPD (n = 60) or OPD (n = 120). They were matched for tumor location, tumor type, tumor size, ASA classification, age, and sex. The main outcome measures included demographics, intraoperative variables, morbidity, postoperative recovery, and mid-term evaluation.

Results

Over the study period, the RLPD group had a significantly longer but decreasing operative time (median 410 vs. 323 min; P < 0.001), less blood loss (median 400 vs. 500 mL; P = 0.005), better nutritional status recovery, expedited off-bed return to activity (3.2 vs. 4.8 d; P < 0.001), faster resumption of bowel movement (3.6 vs. 5.2 d; P < 0.001), and shorter hospital stay (20 vs. 25 d; P = 0.002) compared to the OPD group. The two groups had similar surgical morbidities and mortality as well as R0 resection rate and number of lymph nodes resected. Among patients with pancreatic adenocarcinoma, the two groups had similar overall and disease-free survival (ACTRN12614000299606).

Conclusions

This first largest, prospective matched study demonstrated that for treating selected borderline and malignant pathologies, RLPD was associated with a significant learning curve effect and expedited postoperative recovery, but had a surgical and oncological safety profile similar to OPD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Whipple AO (1945) Pancreaticoduodenectomy for islet carcinoma: a five-year follow-up. Ann Surg 121:847–852

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033

    Article  CAS  PubMed  Google Scholar 

  3. Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410

    Article  CAS  PubMed  Google Scholar 

  4. Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784

    Article  PubMed  Google Scholar 

  5. Cirocchi R, Partelli S, Trastulli S et al (2013) A systematic review on robotic pancreaticoduodenectomy. Surg Oncol 22:238–246

    Article  PubMed  Google Scholar 

  6. Zureikat AH, Moser AJ, Boone BA et al (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258:554–562

    PubMed Central  PubMed  Google Scholar 

  7. Lai EC, Yang GP, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy—a comparative study. Int J Surg 10:475–479

    Article  PubMed  Google Scholar 

  8. Chalikonda S, Aguilar-Saavedra J, Walsh R (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402

    Article  CAS  PubMed  Google Scholar 

  9. Zhou NX, Chen JZ, Liu Q et al (2011) Outcomes of pancreatoduodenectomy with robotic surgery versus open surgery. Int J Med Robot Comp 7:131–137

    Article  Google Scholar 

  10. Buchs NC, Addeo P, Bianco FM et al (2011) Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 35:2739–2746

    Article  PubMed  Google Scholar 

  11. Giulianotti PC, Sbrana F, Bianco FM et al (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657

    Article  PubMed  Google Scholar 

  12. Warshaw AL, Thayer SP (2004) Pancreaticoduodenectomy. J Gastroint Surg 8:733–741

    Article  Google Scholar 

  13. Tempero MA, Arnoletti JP, Behrman SW et al (2012) Pancreatic adenocarcinoma, Version 2.2012 featured updates to the NCCN Guidelines. J Natl Compr Cancer Netw 10:703–713

    CAS  Google Scholar 

  14. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  16. Greene FL (ed) (2002) AJCC cancer staging manual, vol 1. Springer, New York

  17. Gumbs AA, Rivera AMR, Milone L et al (2011) Laparoscopic pancreatoduodenectomy: a review of 285 published cases. Ann Surg Oncol 18:1335–1341

    Article  PubMed  Google Scholar 

  18. Kuroki T, Adachi T, Okamoto T et al (2012) A non-randomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreatico- duodenectomy. Hepatogastroenterol 59:570–573

    Article  Google Scholar 

  19. Cho A, Yamamoto H, Nagata M et al (2009) Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 198:445–449

    Article  PubMed  Google Scholar 

  20. Giulianotti PC, Addeo P, Buchs NC et al (2011) Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas 40:1264–1270

    Article  PubMed  Google Scholar 

  21. Cameron JL, Riall TS, Coleman J et al (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15

    Article  PubMed Central  PubMed  Google Scholar 

  22. Gebauer F, Kloth K, Tachezy M et al (2012) Options and limitations in applying the fistula classification by the International Study Group for Pancreatic Fistula. Ann Surg 256:130–138

    Article  PubMed  Google Scholar 

  23. Dong X, Zhang B, Kang MX et al (2011) Analysis of pancreatic fistula according to the International Study Group on Pancreatic Fistula classification scheme for 294 patients who underwent pancreaticoduodenectomy in a single center. Pancreas 40:222–228

    Article  PubMed  Google Scholar 

  24. Venkat R, Puhan MA, Schulick RD et al (2011) Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy: a novel scoring system. Arch Surg 146:1277–1284

    Article  PubMed  Google Scholar 

  25. Winter JM, Brennan MF, Tang LH et al (2012) Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncology 19:169–175

    Article  Google Scholar 

  26. Jordan GL (1971) Surgical management of postgastrectomy problems. Arch Surg 102:251–259

    Article  PubMed  Google Scholar 

  27. Blachar A, Federle MP, Pealer KM et al (2002) Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings I. Radiology 223:625–632

    Article  PubMed  Google Scholar 

  28. Higa KD, Ho T, Boone KB (2003) Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obesity Surg 13:350–354

    Article  Google Scholar 

  29. Fearon KCH, Ljungqvist O, Von Meyenfeldt M et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477

    Article  CAS  PubMed  Google Scholar 

  30. Caro MMM, Laviano A, Pichard C (2007) Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 26:289–301

    Article  Google Scholar 

  31. Braga M, Ljungqvist O, Soeters P et al (2009) ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr 28:378–386

    Article  CAS  PubMed  Google Scholar 

  32. Kansagara D, Fu R, Freeman M et al (2011) Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med 154:268–282

    Article  PubMed  Google Scholar 

  33. Shimada K, Sakamoto Y, Sano T et al (2006) Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery 139:288–295

    Article  PubMed  Google Scholar 

  34. Slidell MB, Chang DC, Cameron JL et al (2008) Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol 15:165–174

    Article  PubMed  Google Scholar 

  35. Zeh HJ, Zureikat AH, Secrest A et al (2012) Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol 19:864–870

    Article  PubMed  Google Scholar 

  36. Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastroint Surg 4:567–579

    Article  CAS  Google Scholar 

  37. Sargent DJ, Wieand HS, Haller DG et al (2005) Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 23(34):8664–8670

    Article  PubMed  Google Scholar 

  38. Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297(3):267–277

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank all of the volunteer participants and their families. Shi Chen and Jiang-zhi Chen certify that each had a “first author” role equally. Qian Zhan and Cheng-hong Peng also contributed equally, and both should be considered as co-corresponding author. The authors thank Cheng-hui Ma and Zhi-hong Han for their surgery image.

Disclosure

Shi Chen, Jiang-zhi Chen, Qian Zhan, Xia-xing Deng, Bai-yong Shen, Cheng-hong Peng, and Hong-wei Li declares no conflict of interest.

Author information

Author notes

    Authors and Affiliations

    1. Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

      Shi Chen, Jiang-Zhi Chen, Qian Zhan, Xia-Xing Deng, Bai-Yong Shen, Cheng-Hong Peng & Hong-Wei Li

    2. Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China

      Shi Chen

    3. Department of Hepatobiliary Surgery, Union Hospital, Fujian Medical University, Fuzhou, China

      Jiang-Zhi Chen

    4. Department of General Surgery, Research Institute of Pancreatic Disease and Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China

      Qian Zhan & Cheng-Hong Peng

    Authors
    1. Shi Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jiang-Zhi Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Qian Zhan
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Xia-Xing Deng
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Bai-Yong Shen
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Cheng-Hong Peng
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Hong-Wei Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Shi Chen.

    Additional information

    Drs Shi Chen and Jiang-zhi Chen contributed equally to this work, and both should be considered first author. Qian Zhan and Cheng-hong Peng also contributed equally, and both should be considered as co-corresponding author.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (DOCX 32 kb)

    Supplementary material 2 (TIFF 187 kb)

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Chen, S., Chen, JZ., Zhan, Q. et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 29, 3698–3711 (2015). https://doi.org/10.1007/s00464-015-4140-y

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00464-015-4140-y

    Keywords

    Search

    Navigation