Robot-assisted distal pancreatectomy improves spleen preservation rate versus laparoscopic distal pancreatectomy for benign and low-grade malignant lesions of the pancreas

Abstract

Background: The aim of this retrospective study was to compare robot-assisted distal pancreatectomy (RDP) with laparoscopic distal pancreatectomy (LDP) for patients with benign and low-grade malignant lesions of the pancreas.Methods: This study included 166 patients who underwent RDP (n=63) or LDP (n=103) for benign or low-grade malignant lesions of the pancreas from January 2011 to October 2018 in Changhai Hospital. A retrospective analysis was performed between the two groups. The primary points were operation time, operative blood loss, hospital stay, pancreatic fistula and spleen preservation.Results: There were no significant differences in patient characteristics or indications between RDP and LDP. Notably, among all patients, RDP was associated with a significantly higher rate of spleen preservation than that for LDP (30.2% vs. 6.8%, P<0.001), while other intraoperative variables were similar between the two groups. No death cases in the study group within 30 days were reported in either group. Referring to postoperative outcomes, postoperative pancreatic fistula (POPF) was 22% for the RDP group and 33% for the LDP group. In addition, the rate of clinically significant grade B/C pancreatic fistula was 5% and 7%, respectively. There were also no significant differences in hospital stay (6.0±3.0 vs. 6.4±2.5, P=0.404).Furthermore, the univariate analysis demonstrated that tumor size (P=0.001) and surgery group (RDP/LDP) (P=0.002) were associated with SP rate independent factor for spleen preservation.Conclusions: RDP is an effective and safe technique with significant advantage in spleen preservation for patients with benign and low-grade malignant lesions in the distal pancreas.

Short-Term Outcomes of Conventional Laparoscopic versus Robot-Assisted Distal Pancreatectomy for Malignancy: Evidence from US National Inpatient Sample, 2005–2018

“…Over the past 6 to 7 years, several studies have compared laparoscopic and robot-assisted distal pancreatectomy and have provided results similar to those of our study; overall, robotic-assisted surgery offers at last equivalent results as laparoscopic surgery, but with a higher overall medical cost [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. The higher cost has led to some questioning the overall feasibility of a robot-assisted approach [ 21 , 22 , 26 ].…”

“…A multi-center analysis that matched patients undergoing laparoscopic and robot-assisted distal pancreatectomy (402 patients in each group) reported that the robot-assisted procedure was associated with a longer operation time, lower conversion rate, higher spleen preservation rate, longer hospital stay, and lower readmission rate (all, p < 0.05) [ 24 ]. Jiang et al [ 23 ] also reported that robot-assisted distal pancreatectomy was associated with a significantly higher spleen preservation rate compared to laparoscopic surgery in patients with benign and low-grade malignant lesions.…”

Robotic versus laparoscopic distal pancreatectomy on perioperative outcomes: a systematic review and meta-analysis

“…Seven studies [ 13 , 25 , 27 , 28 , 35 , 36 , 42 ] provided detailed data on intraoperative estimated blood loss, respectively. The results showed that RDP led to less intraoperative blood loss (WMD − 58.29, 95% CI − 82.92 to −33.65, p < 0.00001, I 2 = 26%, Fig.…”

“…Thirty studies [ 13 , 16 , 19 , 23 , 25 , 27 – 29 , 32 , 33 , 42 , 45 , 46 ] provided data about the postoperative hospital stay, and the meta-analysis revealed that patients receiving RDP tended to have a shorter postoperative stay than those receiving LDP (WMD − 0.57, 95% CI − 0.92 to − 0.21, p = 0.002, Fig. 7 ), with low heterogeneity ( I 2 = 1%).…”

“…Fifteen studies [ 18 , 19 , 21 , 25 , 29 – 32 , 35 , 36 , 40 , 41 , 44 – 46 ] reported 30-day mortality. Meta-analysis indicated that RDP had lower 30-day mortality (OR 0.28, 95% CI 0.09–0.88, p = 0.03, Fig.…”