Robot-assisted and Laparoscopic Extended Left Pancreatectomy: A Pan-European Multicenter Propensity-score Matched...

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Robot-assisted pancreatectomy (RLP) is increasingly used for complex pancreatic resections.
• Extended RLP (e-RLP) indications are expanding, but its outcomes compared to laparoscopy are not well-established.
• This study addresses the lack of evidence on e-RLP outcomes.

Purpose of the Study:

• To compare postoperative outcomes between extended robot-assisted left pancreatectomy (e-RLP) and extended laparoscopic left pancreatectomy (e-LLP).
• To evaluate the safety and efficacy of e-RLP in complex pancreatic surgeries.

Main Methods:

• An international, pan-European cohort study included patients undergoing e-RLP or e-LLP from 2012-2022.
• Extended resections were defined by the International Study Group for Pancreatic Surgery (ISGPS) criteria.
• Propensity score matching (PSM) in a 1:1 ratio was used to compare outcomes, with major morbidity (Clavien-Dindo grade ≥III) as the primary endpoint.

Main Results:

• After PSM, 119 e-RLP patients were matched with 119 e-LLP patients.
• No significant differences were found in major morbidity (23.5% vs 26.5%), blood loss, conversion rates, mortality, or hospital stay.
• e-RLP was associated with longer operative times (median 277 vs 228 minutes).

Conclusions:

• This study found no significant differences in major morbidity or other key outcomes between matched e-RLP and e-LLP patients.
• e-RLP is a viable option for extended pancreatic resections, offering comparable safety to laparoscopy despite longer operative times.
• The findings support the use of robot-assisted surgery for more extensive pancreatic resections.