Clinical study of robotic pancreatectomy with vascular reconstruction

doi:10.16139/j.1007-9610.2019.02.015

Abstract

Abstract: Objective To evaluate the safety and feasibility of robotic pancreatectomy with vascular reconstruction. Methods The data of 15 patients who underwent robotic pancreatectomy combined with vascular reconstruction were reviewed. There were 8 cases of pancreatoduodenectomy with portal vein (PV) and superior mesenteric vein reconstruction. One case had pancreatoduodenectomy with variant right hepatic artery reconstruction. Four cases had distal pancreatectomy including 2 case with PV reconstruction and 2 cases with common hepatic artery reconstruction. Two cases had total pancreatectomy with PV or SMV reconstruction. Results The operative time was (343+80)(210-540) min with blood loss (573+310)(200-1 100) mL. The postoperative hospital stay was (29.8+27.7)(14-122) d. Pancreatic fistula occurred in 2 cases (13.3%) without mortality. Conclusions Robotic pancreatectomy with vascular reconstruction could be safe and feasible, however, extensive experience with technical support should be needed.

Key words: Robotic surgery, Pancreatic surgery, Vascular reconstruction

CLC Number:

R735.9

SUN Changjie, DENG Xiaxing, SHEN Bai-yong, PENG Chenghong. Clinical study of robotic pancreatectomy with vascular reconstruction[J]. Journal of Surgery Concepts & Practice, 2019, 24(02): 159-162.

References

[1] Siegel RL, Miller KD, Jemal A.Cancer statistics, 2015[J]. CA Cancer J Clin,2015,65(1):5-29.
[2] Kendrick ML.Laparoscopic and robotic resection for pancreatic cancer[J]. Cancer J,2012,18(6):571-576.
[3] Sadot E, Doussot A, O′Reilly EM, et al. FOLFIRINOX induction therapy for stage 3 pancreatic adenocarcinoma[J]. Ann Surg Oncol,2015,22(11):3512-3521.
[4] Boone BA, Steve J, Krasinskas AM, et al.Outcomes with FOLFIRINOX for borderline resectable and locally unresectable pancreatic cancer[J]. J Surg Oncol,2013,108(4):236-241.
[5] Evans DB, Varadhachary GR, Crane CH, et al.Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head[J]. J Clin Oncol,2008,26(21):3496-3502.
[6] Varadhachary GR, Wolff RA, Crane CH, et al.Preope-rative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head[J]. J Clin Oncol,2008,26(21):3487-3495.
[7] Katz MH, Pisters PW, Evans DB, et al.Borderline resectable pancreatic cancer: the importance of this emer-ging stage of disease[J]. J Am Coll Surg,2008,206(5):833-848.
[8] Ferrone CR, Marchegiani G, Hong TS, et al.Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer[J]. Ann Surg,2015,261(1):12-17.
[9] Blazer M, Wu C, Goldberg RM, et al.Neoadjuvant modified (m)FOLFIRINOX for locally advancedunresectable (LAPC) and borderline resectable (BRPC) adenocarcinoma of the pancreas[J]. Ann Surg Oncol,2015,22(4):1153-1159.
[10] Chen S, Chen JZ, Zhan Q, et al.Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study[J]. Surg Endosc,2015,29(12):3698-3711.
[11] Chen S, Zhan Q, Chen JZ, et al.Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study[J]. Surg Endosc,2015,29(12):3507-3518.
[12] Al-Haddad M, Martin JK, Nguyen J, et al.Vascular resection and reconstruction for pancreatic malignancy: a single center survival study[J]. J Gastrointest Surg,2007, 11(9):1168-1174.
[13] Fortner JG.Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results[J]. Ann Surg,1984,199(4):418-425.
[14] Evans DB, Farnell MB, Lillemoe KD, et al.Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement[J]. Ann Surg Oncol,2009,16(7):1736-1744.
[15] Tseng JF, Tamm EP, Lee JE, et al.Venous resection in pancreatic cancer surgery[J]. Best Pract Res,2006,20(2):349-364.
[16] Riediger H, Makowiec F, Fischer E, et al.Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection[J]. J Gastrointest Surg,2006,10(8):1106-1115.
[17] Ramacciato G, Mercantini P, Petrucciani N, et al.Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma?[J]. Ann Surg Oncol,2009,16(4):817-825.
[18] Gagandeep S, Artinyan A, Jabbour N, et al.Extended pancreatectomy with resection of the celiac axis: the modified Appleby operation[J]. Am J Surg,2006,192(3):330-335.
[19] Giulianotti PC, Coratti A, Angelini M, et al.Robotics in general surgery: personal experience in a large community hospital[J]. Arch Surg,2003,138(7):777-784.
[20] Giulianotti PC, Addeo P, Buchs NC, et al.Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors[J]. Pancreas,2011,40(8):1264-1270.
[21] Daouadi M, Zureikat AH, Zenati MS, et al.Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique[J]. Ann Surg,2013,257(1):128-132.
[22] Zureikat AH, Moser AJ, Boone BA, et al.250 robotic pancreatic resections: safety and feasibility[J]. Ann Surg,2013,258(4):554-562.
[23] Dua MM, Tran TB, Klausner J, et al.Pancreatectomy with vein reconstruction: technique matters[J]. HPB(Oxford),2015,17(9):824-831.
[24] Khatkov IE, Izrailov RE, Khisamov AA, et al.Superior mesenteric-portal vein resection during laparoscopic pancreatoduodenectomy[J]. Surg Endosc,2017,31(3):1488-1495.