Feasibility and safety of robotic-assisted total pancreatectomy: a pilot western series

Abstract

This study was designed to demonstrate non-inferiority of robot-assisted total pancreatectomy (RATP) to open total pancreatectomy (OPT) based on an intention-to-treat analysis, having occurrence of severe post-operative complications (SPC) as primary study endpoint. The two groups were matched (2:1) by propensity scores. Assuming a rate of SPC of 22.5% (non-inferiority margin: 15%; α: 0.05; β: 0.20; power: 80%), a total of 25 patients were required per group. During the study period (October 2008–December 2019), 209 patients received a total pancreatectomy. After application of exclusion and inclusion criteria, matched groups were extracted from an overall cohort of 132 patients (OPT: 107; RATP: 25). Before matching, the two groups were different with respect to prevalence of cardiac disease (24.3% versus 4.0%; p = 0.03), presence of jaundice (45.8% versus 12.0%; p = 0.002), presence of a biliary drainage (23.4% versus 0; p = 0.004), history of weight loss (28.0% versus 8.0%; p = 0.04), and vein involvement (55.1% versus 28.0%) (p = 0.03). After matching, the two groups (OTP: 50; RATP: 25) were well balanced. Regarding primary study endpoint, SPC developed in 13 patients (26.0%) after OTP and in 6 patients (24.0%) after RATP (p = 0.85). Regarding secondary study endpoints, RATP was associated with longer median operating times [475 (408.8–582.5) versus 585 min (525–637.5) p = 0.003]. After a median follow-up time of 23.7 months (10.4–71), overall survival time [22.6 (11.2–81.2) versus NA (27.3–NA) p = 0.006] and cancer-specific survival [22.6 (11.2–NA) versus NA (27.3–NA) p = 0.02] were improved in patients undergoing RATP. In carefully selected patients, robot-assisted total pancreatectomy is non-inferior to open total pancreatectomy regarding occurrence of severe post-operative complications.

Pancreatic Ductal Adenocarcinoma: Update of CT-Based Radiomics Applications in the Pre-Surgical Prediction of the Risk of Post-Operative Fistula, Resectability Status and Prognosis

“…Postoperative pancreatic fistula (POPF) is a severe complication caused by pancreatoenteric anastomotic leakage, that occurs in about 10-30% of patients undergoing pancreatic head resection for surgical treatment of pancreatic cancer [112][113][114][115][116][117][118].…”

Short-term outcomes and costs analysis of robotic-assisted versus laparoscopic cholecystectomy—a retrospective single-center analysis

“…In contrast, the adoption appears to be slower in general surgery. However, technically demanding operations such as rectum resection, esophagectomy and gastrectomy, have proven safe and feasible, and the robotic surgical system might be able to bring groundbreaking advantages for the patients post-operative outcome [ 17 – 19 ].…”

Reappraisal of total pancreatectomy in the era of neoadjuvant therapy

“…Future Perspective: On one hand, with the upcoming aim of personalizing PDAC therapy and potential new prognostic markers, TP can be expected to be a solid and widely accepted surgical component for respectively selected patients who can benefit from this approach due to a favourable tumour biology. On the other hand, it can be expected that TP -such as other pancreatic resections -will be increasingly performed minimally-invasive and especially robotically in the future [7]. In addition, further evidence on short-and long-term outcomes will be generated to allow a better evaluation of the true value of such innovative surgical procedures.…”