S Lof1,2, N van der Heijde1, M Abuawwad2, B Al-Sarireh3, U Boggi4, G Butturini5, G Capretti6, A Coratti7, R Casadei8, M D'Hondt9, A Esposito10, G Ferrari11, G Fusai12, A Giardino5, B Groot Koerkamp13, T Hackert14, S Kamarajah15, E F Kauffmann4, T Keck16, R Marudanayagam17, F Nickel14, A Manzoni18, P Pessaux19, A Pietrabissa20, E Rosso21, R Salvia10, Z Soonawalla22, S White15, A Zerbi6, M G Besselink1, M Abu Hilal2,18. 1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 2. Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK. 3. Department of Surgery, Morriston Hospital, Swansea, UK. 4. Division of General and Transplant surgery, University of Pisa, Pisa, Italy. 5. Department of Surgery, Pederzoli Hospital, Peschiera, Italy. 6. Pancreatic Surgery, Humanitas University, Milan, Italy. 7. Department of Surgical Oncology and Robotics, Careggi University Hospital, Florence, Italy. 8. Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy. 9. Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium. 10. Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy. 11. Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 12. Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, UK. 13. Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 14. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany. 15. Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK. 16. Clinic for Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany. 17. Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK. 18. Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy. 19. Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil - IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. 20. Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy. 21. Department of Surgery, Elsan Pôle Santé Sud, Le Mans, France. 22. Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK.
Abstract
BACKGROUND: The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP. METHODS: A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien-Dindo grade IIIa or above). RESULTS: A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004). CONCLUSION: The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.
BACKGROUND: The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP. METHODS: A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien-Dindo grade IIIa or above). RESULTS: A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004). CONCLUSION: The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.
Authors: Pasquale Scognamiglio; Björn-Ole Stüben; Asmus Heumann; Jun Li; Jakob R Izbicki; Daniel Perez; Matthias Reeh Journal: Visc Med Date: 2021-11-12