Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Overview

Journal Ann Surg Open

Publisher Wolters Kluwer

Specialty General Surgery

Date 2024 Jun 24

PMID 38911629

Authors

Niccolo Napoli

Emanuele Federico Kauffmann

Michael Ginesini

Armando Di Dato

Virginia Viti

Cesare Gianfaldoni

Lucrezia Lami

Carla Cappelli

Maria Isabella Rotondo

Daniela Campani

Gabriella Amorese

Caterina Vivaldi

Silvia Cesario

Laura Bernardini

Enrico Vasile

Fabio Vistoli

Ugo Boggi

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to compare robotic pancreatoduodenectomy with vein resection (PD-VR) based on the incidence of severe postoperative complications (SPC).

Background: Robotic pancreatoduodenectomy has been gaining momentum in recent years. Vein resection is frequently required in this operation, but no study has compared robotic and open PD-VR using a matched analysis.

Methods: This was an intention-to-treat study designed to demonstrate the noninferiority of robotic to open PD-VR (2011-2021) based on SPC. To achieve a power of 80% (noninferiority margin:10%; α error: 0.05; ß error: 0.20), a 1:1 propensity score-matched analysis required 35 pairs.

Results: Of the 151 patients with PD-VR (open = 115, robotic = 36), 35 procedures per group were compared. Elective conversion to open surgery was required in 1 patient with robotic PD-VR (2.9%). One patient in both groups experienced partial vein thrombosis. SPC occurred in 7 (20.0%) and 6 patients (17.1%) in the robotic and open PD-VR groups, respectively ( = 0.759; OR: 1.21 [0.36-4.04]). Three patients died after robotic PD-VR (8.6%) and none died after open PD-VR ( = 0.239). Robotic PD-VR was associated with longer operative time (611.1 ± 13.9 minutes vs 529.0 ± 13.0 minutes; < 0.0001), more type 2 vein resection (28.6% vs 5.7%; = 0.0234) and less type 3 vein resection (31.4% vs 71.4%; = 0.0008), longer vein occlusion time (30 [25.3-78.3] minutes vs 15 [8-19.5] minutes; = 0.0098), less blood loss (450 [200-750] mL vs 733 [500-1070.3] mL; = 0.0075), and fewer blood transfusions (intraoperative: 14.3% vs 48.6%; = 0.0041) (perioperative: 14.3% vs 60.0%; = 0.0001).

Conclusions: In this study, robotic PD-VR was noninferior to open PD-VR for SPC. Robotic and open PD-VR need to be compared in randomized controlled trials.

References

Koch M, Garden O, Padbury R, Rahbari N, Adam R, Capussotti L . Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011; 149(5):680-8. DOI: 10.1016/j.surg.2010.12.002. View

Mavros M, Xu L, Maqsood H, Gani F, Ejaz A, Spolverato G . Perioperative Blood Transfusion and the Prognosis of Pancreatic Cancer Surgery: Systematic Review and Meta-analysis. Ann Surg Oncol. 2015; 22(13):4382-91. DOI: 10.1245/s10434-015-4823-6. View

Shyr B, Chen S, Shyr Y, Wang S . Surgical, survival, and oncological outcomes after vascular resection in robotic and open pancreaticoduodenectomy. Surg Endosc. 2019; 34(1):377-383. DOI: 10.1007/s00464-019-06779-x. View

Kauffmann E, Napoli N, Ginesini M, Gianfaldoni C, Asta F, Salamone A . Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction. Surg Endosc. 2023; 37(4):3233-3245. PMC: 10082118. DOI: 10.1007/s00464-022-09860-0. View

Boggi U, Del Chiaro M, Croce C, Vistoli F, Signori S, Moretto C . Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery. 2009; 146(5):869-81. DOI: 10.1016/j.surg.2009.04.029. View

Napoli N, Kauffmann E, Vistoli F, Amorese G, Boggi U . State of the art of robotic pancreatoduodenectomy. Updates Surg. 2021; 73(3):873-880. PMC: 8184559. DOI: 10.1007/s13304-021-01058-8. View

Marino M, Giovinazzo F, Podda M, Ruiz M, Gomez Fleitas M, Pisanu A . Robotic-assisted pancreaticoduodenectomy with vascular resection. Description of the surgical technique and analysis of early outcomes. Surg Oncol. 2020; 35:344-350. DOI: 10.1016/j.suronc.2020.08.025. View

Asbun H, Moekotte A, Vissers F, Kunzler F, Cipriani F, Alseidi A . The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection. Ann Surg. 2019; 271(1):1-14. DOI: 10.1097/SLA.0000000000003590. View

Raptis D, Sanchez-Velazquez P, Machairas N, Sauvanet A, Rueda de Leon A, Oba A . Defining Benchmark Outcomes for Pancreatoduodenectomy With Portomesenteric Venous Resection. Ann Surg. 2020; 272(5):731-737. DOI: 10.1097/SLA.0000000000004267. View

10.

Yang E, Chong Y, Wang Z, Koh Y, Lim K, Goh B . Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study. J Minim Access Surg. 2022; 18(3):420-425. PMC: 9306132. DOI: 10.4103/jmas.jmas_201_21. View

11.

Napoli N, Cacace C, Kauffmann E, Jones L, Ginesini M, Gianfaldoni C . The PD-ROBOSCORE: A difficulty score for robotic pancreatoduodenectomy. Surgery. 2023; 173(6):1438-1446. DOI: 10.1016/j.surg.2023.02.020. View

12.

Besselink M, van Rijssen L, Bassi C, Dervenis C, Montorsi M, Adham M . Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery. Surgery. 2016; 161(2):365-372. DOI: 10.1016/j.surg.2016.06.058. View

13.

Wang J, Ma R, Eleftheriou P, Churilov L, Debono D, Robbins R . Health economic implications of complications associated with pancreaticoduodenectomy at a University Hospital: a retrospective cohort cost study. HPB (Oxford). 2017; 20(5):423-431. DOI: 10.1016/j.hpb.2017.11.001. View

14.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M . The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017; 161(3):584-591. DOI: 10.1016/j.surg.2016.11.014. View

15.

Kim P, Wei A, Atenafu E, Cavallucci D, Cleary S, Moulton C . Planned versus unplanned portal vein resections during pancreaticoduodenectomy for adenocarcinoma. Br J Surg. 2013; 100(10):1349-56. DOI: 10.1002/bjs.9222. View

16.

Kauffmann E, Napoli N, Cacace C, Menonna F, Vistoli F, Amorese G . Resection or repair of large peripancreatic arteries during robotic pancreatectomy. Updates Surg. 2020; 72(1):145-153. DOI: 10.1007/s13304-020-00715-8. View

17.

Beane J, Zenati M, Hamad A, Hogg M, Zeh 3rd H, Zureikat A . Robotic pancreatoduodenectomy with vascular resection: Outcomes and learning curve. Surgery. 2019; 166(1):8-14. DOI: 10.1016/j.surg.2019.01.037. View

18.

Wu W, He J, Cameron J, Makary M, Soares K, Ahuja N . The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol. 2014; 21(9):2873-81. PMC: 4454347. DOI: 10.1245/s10434-014-3722-6. View

19.

Kauffmann E, Napoli N, Ginesini M, Gianfaldoni C, Asta F, Salamone A . Feasibility of "cold" triangle robotic pancreatoduodenectomy. Surg Endosc. 2022; 36(12):9424-9434. PMC: 9652209. DOI: 10.1007/s00464-022-09411-7. View

20.

Wente M, Bassi C, Dervenis C, Fingerhut A, Gouma D, Izbicki J . Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142(5):761-8. DOI: 10.1016/j.surg.2007.05.005. View