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Robotic versus laparoscopic distal pancreatectomy: multicentre analysis.
S Lof1,2, N van der Heijde1, M Abuawwad2
1Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
The British Journal of Surgery
|March 12, 2021
Summary
Robotic distal pancreatectomy (RDP) shows similar major morbidity to laparoscopic distal pancreatectomy (LDP). RDP offers benefits in lower conversion and readmission rates, but with longer surgery and hospital stay.
Area of Science:
- Minimally invasive surgical techniques in oncology.
- Gastrointestinal surgery and surgical innovation.
Background:
- The comparative effectiveness of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP) remains unclear due to a lack of large multicentre studies.
- Minimally invasive approaches are increasingly used for distal pancreatectomy, but optimal technique selection requires further evidence.
Purpose of the Study:
- To compare perioperative outcomes between robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP).
- To evaluate the safety and efficacy of RDP in a large, multicentre setting.
Main Methods:
- A multicentre international propensity score-matched study included 1551 patients undergoing RDP or LDP across 21 European centres (January 2011 to June 2019).
- Propensity score matching (1:1 ratio) was performed based on preoperative characteristics.
- The primary outcome was the rate of major morbidity (Clavien-Dindo grade IIIa or above).
Main Results:
- After matching 402 RDP patients with 402 LDP patients, no significant difference was observed in major morbidity rates (14.2% vs 16.5%, P=0.378).
- Robotic distal pancreatectomy demonstrated a significantly lower conversion rate (6.7% vs 15.2%, P<0.001) and higher spleen preservation rate (81.4% vs 62.9%, P=0.001).
- RDP was associated with a longer operative time (median 285 vs 240 min, P<0.001) and hospital stay (median 8.5 vs 7 days, P<0.001), but a lower readmission rate (11.0% vs 18.2%, P=0.004).
Conclusions:
- Major morbidity rates are comparable between robotic distal pancreatectomy and laparoscopic distal pancreatectomy.
- Robotic distal pancreatectomy offers advantages in terms of reduced conversion rates, enhanced spleen preservation, and lower readmissions, despite longer surgical times and hospital stays.
