Robotic versus open pancreaticoduodenectomy: Is there any difference for frail patients?

Paolini, Claudia; Bencini, Lapo; Gabellini, Linda; Urciuoli, Irene; Pacciani, Sabrina; Tribuzi, Angela; Moraldi, Luca; Calistri, Massimo; Coratti, Andrea

doi:10.1016/j.suronc.2020.12.009

Cited by 9 publications

(5 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 310 articles were identified by the initial search (Figure 1), 43 manuscripts were retrieved for more detailed evaluation, and 18 studies [7,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] were finally included in the systematic review qualitative and quantitative analysis. Relevant data regarding mortality were reported in four studies.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis

Komici

Cappuccio

Scacchi

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Frailty has been associated with increased mortality among hepatobiliary pancreatic (HBP) cancer patients. Nevertheless, estimates of frailty prevalence in HBP cancers and the precise average effect regarding mortality remains uncertain. The present systematic review and meta-analysis aimed to quantify: (1) the prevalence of frailty in patients with liver and pancreatic cancers and (2) the impact of frailty on mortality in patients affected by liver and pancreatic cancers. Methods: MEDLINE/PubMed database search was conducted from inception until November 1st, 2021, the pooled prevalence and relative risk (RR) estimate were calculated. Results: A total of 34,276 patients were identified and the weighted prevalence of frailty was 39%; (95% [C.I.] 23–56; I2 = 99.9%, p < 0.0001). Frailty was significantly associated with increased mortality RR 1.98 (95% [C.I.] 1.49–2.63; I2 = 75.9%, p = 0.006). Conclusions: Frailty prevalence is common among HBP cancer patients and exerts a significant negative impact on survival. These findings are characterized by significant heterogeneity and caution is warranted on their interpretation. However, stratification of patients with HBP cancer by frailty status may provide prognostic information and may inform priorities for decision-making strategy.

show abstract

Section: Resultsmentioning

confidence: 99%

“…In addition, some perioperative parameters such as drain removal and refeeding seem to favor robotic pancreaticoduodenectomy compared to open surgery in frail patients [30] and, in selective cases, robotic surgery may be considered for colorectal cancer liver metastases [65][66][67].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis

Komici

Cappuccio

Scacchi

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Recent studies conducted by Liu et al [44] and Paolini et al [45] compared the outcomes of robotic PD (169) vs. open approach (133) in elderly patients. The robotic PD group had a significant shorter hospitalization period than OPD group.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Bartoș

Mărgărit

Bocse

et al. 2022

Life

View full text Add to dashboard Cite

Background and Aims: Recent single-center retrospective studies have focused on laparoscopic pancreatoduodenectomy (LPD) in elderly patients, and compared the outcomes between the laparoscopic and open approaches. Our study aimed to determine the outcomes of LPD in the elderly patients, by performing a systematic review and a meta-analysis of relevant studies. Methods: A comprehensive literature review was conducted utilizing the Embase, Medline, PubMed, Scopus and Cochrane databases to identify all studies that compared laparoscopic vs. open approach for pancreatoduodenectomy (PD). Results: Five retrospective studies were included in the final analysis. Overall, 90-day mortality rates were significantly decreased after LPD in elderly patients compared with open approaches (RR = 0.56; 95%CI: 0.32–0.96; p = 0.037, I2 = 0%). The laparoscopic approach had similar mortality rate at 30-day, readmission rate in hospital, Clavien–Dindo complications, pancreatic fistula grade B/C, complete resection rate, reoperation for complications and blood loss as the open approach. Additionally, comparing with younger patients (<70 years old), no significant differences were seen in elderly cohort patients regarding mortality rate at 90 days, readmission rate to hospital, and complication rate. Conclusions: Based on our meta-analysis, we identify that LPD in elderly is a safe procedure, with significantly lower 90-day mortality rates when compared with the open approach. Our results should be considered with caution, considering the retrospective analyses of the included studies; larger prospective studies are required.

show abstract

“…These technical advantages facilitate the transition from an open to a minimally invasive approach, as demonstrated by a shorter learning curve in RPD (around 25 procedures) than in LPD (around 39 procedures) 8,11 . Potential advantages of RPD over OPD are less blood loss and less postoperative morbidity in combination with a shorter length of stay with similar short- and long-term oncologic outcomes 5,12 …”

mentioning

confidence: 99%

“…8,11 Potential advantages of RPD over OPD are less blood loss and less postoperative morbidity in combination with a shorter length of stay with similar short-and long-term oncologic outcomes. 5,12 The aim of this study was to compare consecutively performed RPDs from a prospective registry from a very-high volume center with OPD using propensity score matching (PSM) regarding perioperative and short-term oncologic outcomes.…”

mentioning

confidence: 99%

Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy - Propensity Score-matched Analysis

Nickel

Wise

Müller³

et al. 2023

Annals of Surgery

View full text Add to dashboard Cite

Objective: The goal of the current study was to investigate the perioperative outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) in a high-volume center. Summary Background Data: Despite RPD’s prospective advantages over OPD, current evidence comparing the two has been limited.and has prompted further investigation. The aim of this study was to compare both approaches while including the learning curve phase for RPD. Methods: A 1:1 propensity score-matched (PSM) analysis of a prospective database of RPD with OPD (2017-2022) at a high-volume center was performed. Main outcomes were overall- and pancreas specific complications. Results: Of 375 patients who underwent PD (OPD n=276, RPD n=99), 180 were included in PSM analysis (90 per group). RPD was associated with less blood loss (500 (300-800) vs. 750 (400-1000)ml; P=0.006) and less total complications (50% vs. 19%; P<0.001). Operative time was longer (453 (408-529) vs. 306 (247-362)min; P<0.001); in patients with ductal adenocarcinoma, fewer lymph nodes were harvested (24 (18-27) vs. 33 (27-39); P<0.001) with RPD versus OPD. There were no significant differences for major complications (38 vs. 47%; P=0.291), reoperation rate (14% vs. 10%; P=0.495), postoperative pancreatic fistula (21% vs. 23%; P=0.858) and patients with textbook outcome (62% vs. 55%; P=0.452). Conclusions: Including the learning phase, RPD can be safely implemented in high-volume settings and shows potential for improved perioperative outcomes versus OPD. Pancreas-specific morbidity was unaffected by the robotic approach. Randomized trials with specifically trained pancreatic surgeons and expanded indication for the robotic approach are needed.

show abstract

Robotic versus open pancreaticoduodenectomy: Is there any difference for frail patients?

Cited by 9 publications

References 35 publications

The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis

The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis

Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy - Propensity Score-matched Analysis

Contact Info

Product

Resources

About