Author/Authors :
weng, yuanchi shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China , chen, mengmin shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China , gemenetzis, georgios glasgow royal infirmary - department of surgery, Glasgow, UK , shi, yusheng shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China , ying, xiayang shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China , deng, xiaxing shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China , peng, chenghong shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China , jin, jiabin shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China , shen, baiyong shanghai jiaotong university - school of medicine, pancreatic disease center, ruijin hospital - department of general surgery, Shanghai, China
Abstract :
Background: Total pancreatectomy (TP) is a complex surgical procedure with significant postoperative morbidity. Despite the narrowed range of indications for TP, the introduction of neoadjuvant chemotherapy and the increasing complexity of surgical resections performed in high-volume centers has increased the number of annually performed TPs, especially regarding malignant disease. The introduction of roboticassisted pancreatic surgery has provided a novel and minimally invasive approach for TP, yet the feasibility of this technique is still unknown. This study assessed the safety and efficacy of robotic-assisted total pancreatectomy (RTP) compared to conventional open total pancreatectomy (OTP). Methods: All patients who underwent TP between March 2015 and July 2019 in a high-volume institution for pancreatic surgery were included in this retrospective study. Clinical data and perioperative outcomes were derived from the prospectively maintained institutional database. A 1:1 propensity score matching (PSM) method was utilized to compare the RTP and OTP cohorts to minimize bias. Results: A standardized surgical protocol was utilized for RTP following a learning curve of RPD and RDP. The median operative time for patients who underwent RTP was significantly decreased compared to those who underwent OTP [300 (IQR, 250–360) vs. 360 min (IQR, 300–525), P=0.031]. Additionally, en bloc resection and spleen-preserving rates were also higher in the RTP cohort. Major 30-day morbidity (Clavien-Dindo IIIa) and 90-day mortality were similar between the two cohorts. After a median follow-up time of 15 (IQR, 8–24) months, both the RTP and OTP cohorts had a comparable quality of life regarding exocrine and endocrine insufficiency. Conclusions: RTP appears to be safe and feasible when utilized in high-volume centers for the indicated management of benign and highly selected malignant pancreatic disease. However, further prospective randomized studies are needed to assess the feasibility of this approach.
