Robotic versus open pancreaticoduodenectomy with vascular resection for pancreatic ductal adenocarcinoma: surgical and oncological outcomes from pilot experience

Jin, Jiabin; Yin, Shih-Min; Weng, Yiwu; Chen, Mengmin; Shi, Yusheng; Ying, Xiayang; Gemenetzis, Georgios; Zhang, Jun; Deng, Xiaxing; Peng, Chenghong; Shen, Baiyong

doi:10.1007/s00423-021-02364-w

Cited by 15 publications

(21 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The two groups were comparable at the baseline and perioperative results were equivalent. However, 90-day mortality in RPD-VR was 7.1% (versus 4.3% in OPD) [ 43 ]. Yang and coworkers provided a propensity matched comparison between 13 MIPDs with vein resection (including 6 RPDs-VR) and 13 OPDs with vein resection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction

et al. 2023

View full text Add to dashboard Cite

Background Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard of care in patients who responded to neoadjuvant therapies. Feasibility of robotic pancreatoduodenectomy (RPD) with vein resection (RPD-VR) was shown, but no study provided a detailed description of the technical challenges associated with this formidable operation. Herein, we describe the trips and tricks for technically successful RPD-VR. Methods The vascular techniques used in RPD-VR were borrowed from OPD-VR, as well as from our experience with robotic transplantation of both kidney and pancreas. Vein resection was classified into 4 types according to the international study group of pancreatic surgery. Each type of vein resection was described in detail and shown in a video. Results Between October 2008 and November 2021, a total of 783 pancreatoduodenectomies were performed, including 233 OPDs-VR (29.7%). RPD was performed in 256 patients (32.6%), and RPDs-VR in 36 patients (4.5% of all pancreatoduodenectomies; 15.4% of all pancreatoduodenectomies with vein resection; 14.0% of all RPDs). In RPD-VR vein resections were: 4 type 1 (11.1%), 10 type 2 (27.8%), 12 type 3 (33.3%) and 10 type 4 (27.8%). Vascular patches used in type 2 resections were made of peritoneum (n = 8), greater saphenous vein (n = 1), and deceased donor aorta (n = 1). Interposition grafts used in type 4 resections were internal left jugular vein (n = 8), venous graft from deceased donor (n = 1) and spiral saphenous vein graft (n = 1). There was one conversion to open surgery (2.8%). Ninety-day mortality was 8.3%. There was one (2.8%) partial vein thrombosis, treated with heparin infusion. Conclusions We have reported 36 technically successful RPDs-VR. We hope that the tips and tricks provided herein can contribute to safer implementation of RPD-VR. Based on our experience, and according to data from the literature, we strongly advise that RPD-VR is performed by expert surgeons at high volume centers. Graphical abstract

show abstract

Section: Discussionmentioning

confidence: 99%

“…A recent study demonstrates that the risk of thrombosis is higher in type 4 vein resection and reconstruction [ 65 ]. In RPD-VR reported rates of SMV/PV stenosis/thrombosis range between 7 and 9% [ 4 , 43 ]. Therefore, the risk of SMV/PV thrombosis raises the important question on how to manage anticoagulation in these patients.…”

Section: Discussionmentioning

confidence: 99%

Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Accordingly, RPD together with OPD can be seen as one of the standard approaches for type 1 PD (without vascular involvement). In some select centers, RPD even showed appealing results for type 2/3 PD with vascular resection 34–36 . The current level of evidence for RPD is still limited to mainly case-matched series of prospectively maintained data; however, high-quality RCTs are missing.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with PDAC, the R1 rate was similar (27% vs 23%; P = 0.949), but more lymph nodes were harvested in the OPD group [24 (18-27) vs 33 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39); P < 0.001]. The perioperative outcomes for both groups are presented in Table 2.…”

Section: Perioperative Outcomesmentioning

confidence: 97%

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

“…Several other retrospective studies of RPD have been published since, demonstrating acceptable rates of POPF while achieving an adequate lymphadenectomy and acceptable mortality, morbidity, and margin-negative resection rates [Table 1] [45][46][47][48][49][50][51][52][53][54] . A study by Nguyen et al revealed that RPD was safe for patients with aberrant artery anatomy, such as a replaced or accessory left hepatic, right hepatic, or common hepatic artery [55] . Jin et al reviewed PDs with venous resection and reconstruction (VR) in a single high-volume institution and found that RPD-VR had lower lymph node resections but no difference in 3-year survival rates, reconstructed venous patency, or post-operative mortality when compared to open PD-VR [56] .…”

Section: Robotic Pancreaticoduodenectomymentioning

confidence: 99%

Advances in pancreas surgery: robotic pancreaticoduodenectomy

Riachi¹,

Hewitt²

2023

Mini-invasive Surg

View full text Add to dashboard Cite

Surgeon technical improvements made in the 1980s significantly decreased the morbidity and mortality associated with pancreaticoduodenectomy (PD). While minimally invasive surgery (MIS) is now the standard surgical approach for many benign and malignant pathologies, the technical complexity associated with PD presents many challenges to MIS adoption. However, advancements in robotic technology have done much to ameliorate mechanical impediments. Compared to laparoscopic surgery, the robotic platform provides surgeons with enhanced visualization, greater degrees of freedom and range of motion, tremor elimination, and superior ergonomic positioning. Although cost and availability concerns persist, training programs have increasingly incorporated robotic curricula, boosting the prevalence of robotic procedures, including robotic PD (RPD). While prospective data are limited, studies evaluating RPD demonstrate safety, equivalent short-term oncological outcomes, and longer operating times compared to open PD. Furthermore, exciting avenues exist for the future of RPD, ranging from continued instrument innovations to AI-enhanced adjuncts. Robotics has the potential to improve PD for patients and surgeons alike; however, further evaluation of oncologic and surgical outcomes requires well-powered, randomized, prospective trials to confirm the results of earlier retrospective studies, given the significant biases present. In this article, we review the progression of minimally invasive PD, present outcomes from studies evaluating RPD, and discuss areas of innovation for RPD.

show abstract

Robotic versus open pancreaticoduodenectomy with vascular resection for pancreatic ductal adenocarcinoma: surgical and oncological outcomes from pilot experience

Cited by 15 publications

References 45 publications

Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction

Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction

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

Advances in pancreas surgery: robotic pancreaticoduodenectomy

Contact Info

Product

Resources

About