Robotic Versus Laparoscopic Pancreaticoduodenectomy: An Up-To-Date System Review and Meta-Analysis

Ouyang, Lanwei; Zhang, Jia; Feng, Qingbo; Zhang, Zhiguang; Ma, Hexing; Zhang, Guodong

doi:10.3389/fonc.2022.834382

Cited by 23 publications

(12 citation statements)

References 26 publications

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“…The intraoperative blood loss is usually low with minimally invasive PD. 1,10 Similarly, this study showed very low intraoperative blood loss with RPD, with an overall median loss of only 130 mL and nearly no blood loss in six patients. The surgical mortality in our RPD patients was low, at only 1.3% overall, and there was no difference between the early and late groups (1.4% vs. 1.3%).…”

Section: -Year Survival (%) P-valuesupporting

confidence: 59%

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

Shyr,

Chen

et al. 2023

J Hepato Biliary Pancreat

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BackgroundThe role of the robotic approach for pancreaticoduodenectomy has not been well established with robust data. This study aimed to reappraise feasibility and justification of robotic pancreaticoduodenectomy (RPD) over time.MethodsA total of 500 patients undergoing RPD were enrolled and divided into early (first 250 patients) and late (last 250 patients) groups for a comparative study.ResultsThe conversion rate was 8.8% overall and was significantly lower in the late group (5.6% vs. 12.0%; p = .012). The overall median intraoperative blood loss was 130 mL. Radicality of resection was similar between early and late groups. The overall surgical mortality after RPD was 1.3%. The overall surgical morbidity and major complication was 44.1% and 13.2%, respectively, and similar between early and late groups. Chyle leakage was the most common complication after RPD (25.0%), followed by postoperative pancreatic fistula (POPF). The POPF rate was 8.6% overall, with 5.9% in the early group and 11.0% in the late group, p = .051. The overall delayed gastric emptying rate was 3.5%. The late group had better survival outcomes than those of the early group after RPD for ampullary adenocarcinoma (p = .027) but not for pancreatic head adenocarcinoma.ConclusionsReappraisal of this study has confirmed that RPD is not only technically feasible without increasing surgical risks but also oncologically justified without compromising survival outcomes for both pancreatic head and other periampullary cancers over time. Moreover, RPD is associated with the benefits of low surgical mortality, blood loss, and delayed gastric emptying.

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Section: -Year Survival (%) P-valuesupporting

confidence: 59%

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

Shyr,

Chen

et al. 2023

J Hepato Biliary Pancreat

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“…Robotic surgery provides additional advantages over laparoscopic surgery, including high‐resolution three‐dimensional visualization, precise tissue manipulation with articulated forceps, and tremor filtration. A meta‐analysis has suggested that robotic pancreatectomy is associated with better perioperative outcomes, including a lower conversion rate, less estimated blood loss, and more lymph node retrieval, than laparoscopic pancreatectomy 9,10 . The present report is the first to discuss repeated robotic pancreatectomies for malignancy with no problematic postoperative clinical course.…”

Section: Discussionmentioning

confidence: 79%

“…A metaanalysis has suggested that robotic pancreatectomy is associated with better perioperative outcomes, including a lower conversion rate, less estimated blood loss, and more lymph node retrieval, than laparoscopic pancreatectomy. 9,10 The present report is the first to discuss repeated robotic pancreatectomies for malignancy with no problematic postoperative clinical course. We believe that the contribution of robotic surgery was prominent, especially in the second pancreatectomy.…”

Section: Discussionmentioning

confidence: 84%

Repeated robotic pancreatectomy for recurrent pancreatic metastasis of mesenchymal chondrosarcoma: A case report

Hayashida

Ikenaga

Nakata

et al. 2023

Asian J Endoscop Surgery

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Mesenchymal chondrosarcoma is a rare subset of sarcomas accounting for 3%–10% of all cases of chondrosarcomas. Radical resection is the only curative strategy, even in patients with metastatic tumors. However, data regarding treatment strategies remain limited owing to the small number of cases. Herein, we report a patient who underwent repeated robotic pancreatectomy for recurrent pancreatic metastasis originating from extraskeletal mesenchymal chondrosarcoma of the pelvis. First, robotic pancreaticoduodenectomy with a reconstruction of pancreaticogastrostomy was performed for synchronous pancreatic metastasis 5 months after the primary resection of mesenchymal chondrosarcoma. Ten months after robotic pancreaticoduodenectomy, tumor recurrence was observed at the tail end of the pancreas, which was removed by reperforming robotic distal pancreatectomy. Given the precise tissue manipulation that can be achieved with robotic articulated forceps, the peripheral splenic artery and pancreas were easily isolated and divided in close proximity to the tumor. The central part of the pancreas was preserved. Robotic surgery allowed safe and effective resection of the reconstructed remnant pancreas. The patient survived for 28 months after primary tumor resection. Repeated pancreatectomy with minimally invasive techniques is a feasible and curative treatment for metastatic mesenchymal chondrosarcoma.

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“…The results of this study show that RPD has less intraoperative blood loss and a smaller proportion of intraoperative transfusions compared with OPD and LPD, demonstrating its reliability and safety, which is consistent with the results in recent studies. 4,27,28 Previous studies 7,8,29 have reported that RPD increases the operation time compared with OPD and LPD. However, the operation time of RPD in this study was shorter than OPD.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

Yu,

Du,

Lin

et al. 2023

J of Gastro and Hepatol

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Background and AimHealthcare‐associated infections (HAIs) after pancreaticoduodenectomy (PD) are one of the common postoperative complications. This study aims to investigate the epidemiology of postoperative HAIs in patients with open pancreaticoduodenectomy (OPD) and robotic pancreaticoduodenectomy (RPD).MethodsThis retrospective cohort study described the trend of HAIs in patients undergoing PD from January 2013 to December 2022 at a tertiary hospital. Patients were divided into OPD and RPD, and the HAIs and outcomes were compared.ResultsAmong 2632 patients who underwent PD, 230 (8.7%, 95% confidence interval [CI] 7.7–9.9%) were diagnosed with HAIs, with a decreasing trend from 2013 to 2022 (P < 0.001 for trend). The incidence of postoperative HAIs was significantly higher in patients with OPD than RPD (9.6% vs 5.8%; P = 0.003). The incidence of HAIs for patients with OPD showed a decreasing trend (P = 0.001 for trend), and the trend for RPD was not significant (P = 0.554 for trend). Logistic regression showed that RPD was significantly associated with postoperative HAIs after adjusting for covariates (adjusted odds ratio = 0.654; 95% CI 0.443–0.965; P = 0.032), especially in the subgroup of patients without preoperative biliary drainage (adjusted odds ratio = 0.486; 95% CI 0.292–0.809; P = 0.006). Regarding clinical outcomes, RPD has a shorter length of stay and a more expensive charge than OPD (all P < 0.05).ConclusionPostoperative HAIs in patients with PD showed a decreasing trend in recent years, especially in OPD. RPD was significantly associated with reduced postoperative HAIs and length of stay, although the charge is more expensive. Attention should be paid to postoperative HAIs in OPD, and it is imperative to continue reducing the costs of RPD.

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Robotic Versus Laparoscopic Pancreaticoduodenectomy: An Up-To-Date System Review and Meta-Analysis

Cited by 23 publications

References 26 publications

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

Repeated robotic pancreatectomy for recurrent pancreatic metastasis of mesenchymal chondrosarcoma: A case report

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

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