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Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective
Eduard A van Bodegraven1,2, Tess M E van Ramshorst1,2,3, Svein O Bratlie4
1Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Background:
International guidelines recommend monitoring the use and outcome of minimally invasive pancreatic surgery (MIPS). However, data from prospective international audits on minimally invasive distal pancreatectomy (MIDP) are lacking. This study examined the use and outcome of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the E-MIPS registry.
Patients And Methods:
Post-hoc analysis in a prospective audit on MIPS, including consecutive patients undergoing MIDP in 83 centers from 19 European countries (01-01-2019/31-12-2021). Primary outcomes included intraoperative events (grade 1: excessive blood loss, grade 2: conversion/change in operation, grade 3: intraoperative death), major morbidity, and in-hospital/30-day mortality. Multivariable logistic regression analyses identified high-risk groups for intraoperative events. RDP and LDP were compared in the total cohort and high-risk groups.
Results:
Overall, 1672 patients undergoing MIDP were included; 606 (36.2%) RDP and 1066 (63.8%) LDP. The annual use of RDP increased from 30.5% to 42.6% ( P <0.001). RDP was associated with fewer grade 2 intraoperative events compared with LDP (9.6% vs. 16.8%, P <0.001), with longer operating time (238 vs. 201 min, P <0.001). No significant differences were observed between RDP and LDP regarding major morbidity (23.4% vs. 25.9%, P =0.264) and in-hospital/30-day mortality (0.3% vs. 0.8%, P =0.344). Three high-risk groups were identified; BMI greater than 25 kg/m 2 , previous abdominal surgery, and vascular involvement. In each group, RDP was associated with fewer conversions and longer operative times.
Conclusion:
This European registry-based study demonstrated favorable outcomes for MIDP, with mortality rates below 1%. LDP remains the predominant approach, whereas the use of RDP is increasing. RDP was associated with fewer conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.
Insights
Robot-assisted distal pancreatectomy (RDP) shows fewer intraoperative events than laparoscopic distal pancreatectomy (LDP), with similar major morbidity and mortality. RDP use is increasing in minimally invasive distal pancreatectomy (MIDP).
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Pancreatic Surgery
Background:
- International guidelines advocate for monitoring minimally invasive pancreatic surgery (MIPS).
- Prospective international audit data on minimally invasive distal pancreatectomy (MIDP) are limited.
- The E-MIPS registry provides a platform to evaluate robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy.
Purpose of the Study:
- To examine the utilization and outcomes of RDP versus LDP within the E-MIPS registry.
- To identify intraoperative events, major morbidity, and mortality associated with MIDP.
- To compare RDP and LDP in both the overall cohort and high-risk patient groups.
Main Methods:
- A post-hoc analysis of a prospective audit of MIPS in 83 European centers (2019-2021).
- Inclusion of consecutive patients undergoing MIDP, comparing RDP and LDP.
- Multivariable logistic regression identified high-risk factors for intraoperative events.
Main Results:
- 1672 MIDP cases analyzed: 606 RDP (36.2%) and 1066 LDP (63.8%).
- RDP showed fewer grade 2 intraoperative events (9.6% vs. 16.8%) but longer operating times (238 vs. 201 min).
- No significant differences in major morbidity or mortality between RDP and LDP.
Conclusions:
- MIDP demonstrates favorable outcomes with low mortality (<1%).
- LDP is prevalent, but RDP utilization is rising.
- RDP is associated with fewer conversions, particularly in high-risk patients, warranting further investigation.
