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A retrospective comparison of robotic versus laparoscopic distal resection and enucleation for potentially benign pancreatic neoplasms

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Abstract

Purpose

The present study aimed to compare robotic-assisted versus laparoscopic distal pancreatic resection and enucleation for potentially benign pancreatic neoplasms.

Methods

Patients were retrieved from a prospectively maintained database. Demographic data, tumor types, and the perioperative outcomes were retrospectively analyzed.

Results

In a 10-year period, 75 patients (female, n = 44; male, n = 31; median age, 53 years [range, 9–84 years]) were identified. The majority of patients had pancreatic neuroendocrine neoplasms (n = 39, 52%) and cystic neoplasms (n = 23, 31%) with a median tumor size of 17 (3–60) mm. Nineteen (25.3%) patients underwent enucleation (robotic, n = 11; laparoscopic, n = 8) and 56 (74.7%) patients underwent distal pancreatic resection (robotic, n = 24; laparoscopic, n = 32), of those 48 (85%) underwent spleen-preserving procedures. Eight (10.7%) procedures had to be converted to open surgery. The rate of vessel preservation in distal pancreatectomy was significantly higher in robotic-assisted procedures (62.5% vs. 12.5%, p = 0.01). Twenty-six (34.6%) patients experienced postoperative complications (Clavien–Dindo grade > 3). Twenty (26.7%) patients developed a pancreatic fistula type B. There was no mortality. After a median follow-up period of 58 months (range 2–120 months), one patient (1.3%) developed local recurrence (glucagonoma) after enucleation, which was treated with a Whipple procedure.

Conclusion

The robotic approach is comparably safe, but increases the rate of splenic vessel preservation and reduces the risk of conversion to open surgery.

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References

  1. Merchant NB, Parikh AA, Kooby DA. Should all distal pancreatectomies be performed laparoscopically? Adv Surg. 43:283–300. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19845186

  2. Niu X, Yu B, Yao L, Tian J, Guo T, et al. Comparison of surgical outcomes of robot-assisted laparoscopic distal pancreatectomy versus laparoscopic and open resections: a systematic review and meta-analysis. Asian J Surg. 2018;42(1):32–45. https://doi.org/10.1016/j.asjsur.2018.08.011.

    Article  PubMed  Google Scholar 

  3. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 2012. https://doi.org/10.1097/SLA.0b013e318251ee09.

    Article  PubMed  Google Scholar 

  4. Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: It’s time to randomize. Surgery (United States). 2015. https://doi.org/10.1016/j.surg.2014.06.081.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nigri GR, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, et al. Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc. 2010;25(5):1642–51. https://doi.org/10.1007/s00464-010-1456-5.

    Article  PubMed  Google Scholar 

  6. Soh YF, Kow AWC, Wong KY, Wang B, Chan CY, Liau KH, et al. Perioperative outcomes of laparoscopic and open distal pancreatectomy: our institution’s 5-year experience. Asian J Surg. 2012. https://doi.org/10.1016/j.asjsur.2012.04.005.

    Article  PubMed  Google Scholar 

  7. Duran H, Ielpo B, Caruso R, Ferri V, Quijano Y, Diaz E, et al. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot Comput Assist Surg MRCAS. 2014;10(3):280–5. https://doi.org/10.1002/rcs.1569.

    Article  Google Scholar 

  8. Lee SY, Allen PJ, Sadot E, D’Angelica MI, Dematteo RP, Fong Y, et al. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg. 2015. https://doi.org/10.1016/j.jamcollsurg.2014.10.004.

    Article  PubMed  Google Scholar 

  9. Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MGH, Davidson BR, et al. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev. 2016;4:CD011391. https://doi.org/10.1002/14651858.CD011391.pub2.

    Article  PubMed  Google Scholar 

  10. Xourafas D, Ashley SW, Clancy TE. Comparison of perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy: an analysis of 1815 patients from the ACS-NSQIP procedure-targeted pancreatectomy database. J Gastrointest Surg. 2017;21(9):1442–52. https://doi.org/10.1007/s11605-017-3463-5.

    Article  PubMed  Google Scholar 

  11. Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, et al. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc Other Interv Tech. 2005;19(1):117–9. https://doi.org/10.1007/s00464-004-9004-9.

    Article  CAS  Google Scholar 

  12. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S. Balestracci S et al Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138(7):777–84. https://doi.org/10.1001/archsurg.138.7.777.

    Article  PubMed  Google Scholar 

  13. Van Koughnett JA, Jayaraman S, Eagleson R, Quan D, van Wynsberghe A, Schlachta CM. Are there advantages to robotic-assisted surgery over laparoscopy from the surgeon’s perspective? J Robot Surg. 2009;3(2):79–82. https://doi.org/10.1007/s11701-009-0144-8.

    Article  PubMed  Google Scholar 

  14. Xu SB, Jia CK, Wang JR, Zhang RC, Mou YP. Do patients benefit more from robot assisted approach than conventional laparoscopic distal pancreatectomy? A meta-analysis of perioperative and economic outcomes. J Formos Med Assoc. 2018. https://doi.org/10.1016/j.jfma.2018.05.003.

    Article  PubMed  Google Scholar 

  15. Eckhardt S, Schicker C, Maurer E, Fendrich V, Bartsch DK. Robotic-assisted approach improves vessel preservation in spleen-preserving distal pancreatectomy. Dig Surg. 2016;33(5):406–13. https://doi.org/10.1159/000444269.

    Article  PubMed  Google Scholar 

  16. Chen S, Zhan Q, Chen J, Jin J, Deng X, Chen H, et al. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc. 2015;29(12):3507–18. https://doi.org/10.1007/s00464-015-4101-5.

    Article  PubMed  Google Scholar 

  17. Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg. 2013;257(1):128–32. https://doi.org/10.1097/SLA.0b013e31825fff08.

    Article  PubMed  Google Scholar 

  18. Goh BKP, Chan CY, Soh HL, Lee SY, Cheow PC, Chow PKH, et al. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. Int J Med Robot Comput Assist Surg. 2017. https://doi.org/10.1002/rcs.1733.

    Article  Google Scholar 

  19. Kang CM, Kim DH, Lee WJ, Chi HS. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc. 2011;25(6):2004–9. https://doi.org/10.1007/s00464-010-1504-1.

    Article  PubMed  Google Scholar 

  20. Zhou JY, Xin C, Mou YP, Xu XW, Zhang MZ, Zhou YC, et al. Robotic versus laparoscopic distal pancreatectomy: a meta-analysis of short-term outcomes. PLoS ONE. 2016;11(3):1–13. https://doi.org/10.1371/journal.pone.0151189.

    Article  CAS  Google Scholar 

  21. Guerrini GP, Lauretta A, Belluco C, Olivieri M, Forlin M, Basso S, et al. Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg. 2017;17(1):1–10. https://doi.org/10.1186/s12893-017-0301-3.

    Article  Google Scholar 

  22. Strijker M, Van Santvoort HC, Besselink MG, Van Hillegersberg R, Borel Rinkes IHM, Vriens MR, et al. Robot-assisted pancreatic surgery: a systematic review of the literature. Hpb. 2012;15(1):1–10. https://doi.org/10.1111/j.1477-2574.2012.00589.x.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Liu R, Liu Q, Zhao ZM, Tan XL, Gao YX, Zhao GD. Robotic versus laparoscopic distal pancreatectomy: a propensity score-matched study. J Surg Oncol. 2017;116(4):461–9. https://doi.org/10.1002/jso.24676.

    Article  PubMed  Google Scholar 

  24. Lyman WB, Passeri M, Sastry A, Cochran A, Iannitti DA, Vrochides D, et al. Robotic-assisted versus laparoscopic left pancreatectomy at a high-volume, minimally invasive center. Surg Endosc. 2019. https://doi.org/10.1007/s00464-018-6565-6.

    Article  PubMed  Google Scholar 

  25. Mintziras I, Keck T, Werner J, Fichtner-Feigl S, Wittel U, et al. Implementation of current ENETS guidelines for surgery of small (≤2 cm) pancreatic neuroendocrine neoplasms in the german surgical community: an analysis of the prospective DGAV StuDoQ|Pancreas registry. World J Surg. 2019;43(1):175–82. https://doi.org/10.1007/s00268-018-4751-2.

    Article  PubMed  Google Scholar 

  26. Kimura W, Yano M, Sugawara S, Okazaki S, Sato T, Moriya T, Hirai I. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance. J Hepato-Biliary-Pancreat Sci. 2010;17(6):813–23. https://doi.org/10.1007/s00534-009-0250-z.

    Article  Google Scholar 

  27. Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg (Chicago, Ill. : 1960), 1988;123(5):550–553. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3358679

  28. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  29. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584–91. https://doi.org/10.1016/j.surg.2016.11.014.

    Article  Google Scholar 

  30. Gavriilidis P, Lim C, Menahem B, Lahat E, Salloum C, Azoulay D. Robotic versus laparoscopic distal pancreatectomy—the first meta-analysis. Hpb. 2016;18(7):567–74. https://doi.org/10.1016/j.hpb.2016.04.008.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kamarajah SK, Sutandi N, Robinson SR, French JJ, White SA. Robotic versus conventional laparoscopic distal pancreatic resection: a systematic review and meta-analysis. Hpb. 2019;21(9):1107–18. https://doi.org/10.1016/j.hpb.2019.02.020.

    Article  PubMed  Google Scholar 

  32. Kyoung H, Chang H, Kang M. Robot-assisted spleen-preserving distal pancreatectomy : a single surgeon ’ s experiences and proposal of clinical application. Surg Endosc. 2013. https://doi.org/10.1007/s00464-012-2551-6.

    Article  Google Scholar 

  33. Shoup M, Brennan MF, McWhite K, Leung DHY, Klimstra D, Conlon KC. The value of splenic preservation with distal pancreatectomy. Arch Surg (Chicago, Ill: 1960). 2013;137(2):164–168. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11822953

  34. Koukoutsis I, Tamijmarane A, Bellagamba R, Bramhall S, Buckels J, Mirza D. The impact of splenectomy on outcomes after distal and total pancreatectomy. World J Surg Oncol. 2007;5:61. https://doi.org/10.1186/1477-7819-5-61.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Boselli C, Barberini F, Listorti C, Castellani E, Renzi C, Corsi A, et al. Distal pancreatectomy with splenic preservation: a short-term outcome analysis of the Warshaw technique. Int J Surg. 2015. https://doi.org/10.1016/j.ijsu.2015.06.051.

    Article  PubMed  Google Scholar 

  36. Yu X, Li H, Jin C, Fu D, Di Y, Hao S, et al. Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbeck’s Arch Surg. 2015;400(2):183–91. https://doi.org/10.1007/s00423-015-1273-3.

    Article  Google Scholar 

  37. Matsushima H, Kuroki T, Adachi T, Kitasato A, Hirabaru M, Eguchi S. Laparoscopic spleen-preserving distal pancreatectomy Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: the role of the Warshaw procedure Laparoscopic spleen-preserving distal pancreatectomy.

  38. Lü S, Shi X, Wang H, Ji W, Wan T, Xu M, et al. Follow-up studies for long-term postoperative complications of Warshaw operation. Zhonghua Yi Xue Za Zhi. 93(14):1096–1098. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23902845

  39. Ferrone CR, Konstantinidis IT, Sahani DV, Wargo JA, Fernandez-Del Castillo C, Warshaw AL. Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg. 2011;253:1136–9. https://doi.org/10.1097/SLA.0b013e318212c1e2.

    Article  PubMed  Google Scholar 

  40. Goh BKP, Chan CY, Lee SY, Chan WH, Cheow PC, Chow PKH, et al. Factors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution. ANZ J Surg. 2017. https://doi.org/10.1111/ans.13661.

    Article  PubMed  Google Scholar 

  41. Hanna EM, Rozario N, Rupp C, Sindram D, Iannitti DA, Martinie JB. Robotic hepatobiliary and pancreatic surgery: lessons learned and predictors for conversion. Int J Med Robot Comput Assist Surg MRCAS. 2013;9(2):152–9. https://doi.org/10.1002/rcs.1492.

    Article  Google Scholar 

  42. Butturini G, Damoli I, Crepaz L, Malleo G, Marchegiani G, Daskalaki D, et al. A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc. 2015;29(11):3163–70. https://doi.org/10.1007/s00464-014-4043-3.

    Article  PubMed  Google Scholar 

  43. Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet. 2011;377(9776):1514–22. https://doi.org/10.1016/S0140-6736(11)60237-7.

    Article  PubMed  Google Scholar 

  44. Zhou W, Lv R, Wang X, Mou Y, Cai X, Herr I. Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg. 2009;200(4):529–36. https://doi.org/10.1016/j.amjsurg.2009.12.022.

    Article  Google Scholar 

  45. Probst P, Huttner FJ, Klaiber U, Knebel P, Ulrich A, Buchler MW, et al. Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev. 2015;11:Cd008688.

  46. Hüttner FJ, Koessler-Ebs J, Hackert T, Ulrich A, Büchler MW, Diener MK. Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms. Br J Surg. 2015;102(9):1026–36. https://doi.org/10.1002/bjs.9819.

    Article  PubMed  Google Scholar 

  47. Jin JB, Qin K, Li H, Wu ZC, Zhan Q, Deng XX, et al. Robotic enucleation for benign or borderline tumours of the pancreas: a retrospective analysis and comparison from a high-volume centre in Asia. World J Surg. 2016;40(12):3009–200. https://doi.org/10.1007/s00268-016-3655-2.

    Article  PubMed  Google Scholar 

  48. Tian F, Hong XF, Wu WM, Han XL, Wang MY, Cong L, et al. Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours. Br J Surg. 2016;103(10):1358–64. https://doi.org/10.1002/bjs.10220.

    Article  CAS  PubMed  Google Scholar 

  49. Zhang RC, Zhou YC, Mou YP, Huang CJ, Jin WW, Yan JF, et al. Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis. Surg Endosc. 2016;30(7):2657–65. https://doi.org/10.1007/s00464-015-4538-6.

    Article  PubMed  Google Scholar 

  50. Belfiori G, Wiese D, Partelli S, Wächter S, Maurer E, Crippa S, et al. Minimally invasive versus open treatment for benign sporadic insulinoma comparison of short-term and long-term outcomes. World J Surg. 2018;42(10):3223–300. https://doi.org/10.1007/s00268-018-4628-4.

    Article  PubMed  Google Scholar 

  51. Drymousis P, Raptis DA, Spalding D, Fernandez-Cruz L, Menon D, et al. Laparoscopic versus open pancreas resection for pancreatic neuroendocrine tumours: a systematic review and meta-analysis. Hpb. 2014;16(5):397–406. https://doi.org/10.1111/hpb.12162.

    Article  PubMed  Google Scholar 

  52. Heeger K, Falconi M, Partelli S, Waldmann J, Crippa S, Fendrich V, et al. Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. Langenbeck’s Arch Surg. 2014;399(3):315–21. https://doi.org/10.1007/s00423-014-1171-0.

    Article  Google Scholar 

  53. Beger HG. Benign tumors of the pancreas—radical surgery versus parenchyma-sparing local resection—the challenge facing surgeons. J Gastrointest Surg. 2018. https://doi.org/10.1007/s11605-017-3644-2.

    Article  PubMed  Google Scholar 

  54. Fernández-Cruz L, Molina V, Vallejos R, Jiménez Chavarria E, Lõpez-Boado MA, et al. Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours. Hpb. 2012;14(3):171–6. https://doi.org/10.1111/j.1477-2574.2011.00422.x.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Falconi M, Zerbi A, Crippa S, Balzano G, Boninsegna L, et al. Parenchyma preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann Surg Oncol. 2010;17:1621–7. https://doi.org/10.1245/s10434-010-0949-8.

    Article  PubMed  Google Scholar 

  56. Zhou Y, Zhao M, Wu L, Ye F, Si X. Short- and long-term outcomes after enucleation of pancreatic tumors: an evidence-based assessment. Pancreatology. 2016;16(6):1092–8. https://doi.org/10.1016/j.pan.2016.07.006.

    Article  PubMed  Google Scholar 

  57. Su AP, Ke NW, Zhang Y, Liu XB, Hu WM, et al. Is laparoscopic approach for pancreatic insulinomas safe? Results of a systematic review and meta-analysis. J Surg Res. 2014;186(1):126–34. https://doi.org/10.1016/j.jss.2013.07.051.

    Article  PubMed  Google Scholar 

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  1. Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Nawid Najafi, I. Mintziras, D. Wiese, M. B. Albers, E. Maurer & D. K. Bartsch

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  1. Nawid Najafi
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Najafi, N., Mintziras, I., Wiese, D. et al. A retrospective comparison of robotic versus laparoscopic distal resection and enucleation for potentially benign pancreatic neoplasms. Surg Today 50, 872–880 (2020). https://doi.org/10.1007/s00595-020-01966-z

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