Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study.

Abstract

BACKGROUND:

Spleen preservation (SP) is beneficial for patients undergoing distal pancreatectomy of benign and borderline tumors; however, the conventional laparoscopy approach (C-LDP) is less effective in controlling splenic vessel bleeding. The benefits of the robotic-assisted approach (RA-LDP) in SP have not been clearly described. This study aimed to evaluate whether a robotic approach could improve SP rate and effectiveness/safety profile of laparoscopic distal pancreatectomy (LDP).

METHODS:

Matched for scheduled SP, age, sex, ASA classification, tumor size, tumor location, and pathological type, 69 patients undergoing RA-LDP and 50 undergoing C-LDP between January 2005 and May 2014 were included. Main outcome measures included SP rate, operative time (OT), blood loss, transfusion frequency, morbidity, postoperative hospital stay (PHS), and oncologic safety.

RESULTS:

Among matched patients scheduled for SP, RA-LDP was associated with significantly higher overall (95.7 vs. 39.4%) and Kimura SP rates (72.3 vs. 21.2%), shorter OT (median 120 vs. 200 min), less blood loss (median 100 vs. 300 mL), lower transfusion frequency (2.1 vs. 18.2%), and shorter mean PHS (10.2 vs. 14.5 days). Among matched patients scheduled for splenectomy, RA-LDP was associated with similar OT, blood loss, transfusion frequency, and PHS. The two approaches were similar in overall morbidity, frequency of pancreatic fistula, and oncologic outcome among patients undergoing splenectomy for malignant tumors.

CONCLUSIONS:

RA-LDP was associated with a significantly better SP rate and reduced OT, blood loss, transfusion requirement, and PHS for patients undergoing SP compared to C-LDP, but offered less benefits for patients undergoing splenectomy.

• Authors: Shi Chen, Qian Zhan, Jiang-zhi Chen, Jia-bin Jin, Xia-xing Deng, Hao Chen, Bai-yong Shen, Cheng-hong Peng, Hong-wei Li
• Journal: Surgical endoscopy (Surg Endosc) Vol. 29 Issue 12 Pg. 3507-18 (Dec 2015) ISSN: 1432-2218 [Electronic] Germany
• PMID: 25791063 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Analysis of Variance
• Blood Loss, Surgical (statistics & numerical data)
• Blood Transfusion (statistics & numerical data)
• Cohort Studies
• Female
• Humans
• Laparoscopy (methods)
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Operative Time
• Organ Sparing Treatments (methods)
• Pancreatectomy (adverse effects, methods)
• Pancreatic Fistula (etiology)
• Pancreatic Neoplasms (mortality, surgery)
• Postoperative Period
• Reoperation (statistics & numerical data)
• Robotic Surgical Procedures
• Spleen (surgery)
• Surgery, Computer-Assisted (methods)
• Treatment Outcome