Original article

Experience of robotic middle pancreatectomy: a report of 177 cases

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  • Department of Surgery, Research Institute of Pancreatic Disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2019-03-18

  Online published: 2019-06-25

Abstract

Objectives Clinical effect and postoperative complications were compared between robotic middle pancreatectomy (RMP) and open middle pancreatectomy (OMP). Methods Retrospective study was done with 177 patients of the demographics and perioperative data including 115 cases of RMP group and 62 cases of OMP group in our hospital from December 2010 to December 2017. Results There were 41 male and 74 female with mean age (46.9± 14.2) years in RMP group, and 25 male and 37 female with age (53.0± 13.7) years in OMP group. It was seen biochemical pancreatic leakage 14 cases (12.2%) in RMP group and 7 cases (11.3%) in OMP group. Only pancreatic leakage grade B was present 38 ca-ses (33%) in RMP group. Pancreatic leakage grade B and C were present 14 cases (22.6%) in OMP group. Length of hospital stay was (24.5± 12.8) days in RMP group and (23.3± 17.8) days in OMP group (P>; 0.05). There was significant difference in operative time and intraoperative blood loss between 2 groups(P< 0.001). A total of 14 cases were found postoperative bleeding with treatment of digital subtraction angiography in 6 cases and reoperation in 6 cases and nonoperative hemostasis in 1 case. There was 1 case death for severe postoperative bleeding and other case death for acute pulmonary embolism. Conclusions Postoperative pancreatic leakage is still main complication of both RMP and OMP. RMP could be safe now with advantages of minimal invasive surgery.

Cite this article

SHI Yusheng, WANG Yue, QIN Kai, WENG Yuanchi, ZHAO Shulin, ZHAI Shuyu, TANG Xiaomei, HUO Zhen, DENG Xiaxing, SHEN Baiyong, PENG Chenghong . Experience of robotic middle pancreatectomy: a report of 177 cases[J]. Journal of Surgery Concepts & Practice, 2019 , 24(03) : 215 -221 . DOI: 10.16139/j.1007-9610.2019.03.009

References

[1] Fitzgerald TL, Hickner ZJ, Schmitz M, et al.Changing incidence of pancreatic neoplasms: a 16-year review of statewide tumor registry[J]. Pancreas,2008,37(2):134-138.
[2] Lee KS, Flusberg M, Haramati LB, et al.Prevalence of incidental pancreatic cysts in the adult population on MR imaging[J]. Am J Gastroenterol,2010,105(9):2079-2084.
[3] Hackert T, Hinz U, Fritz S, et al.Enucleation in pancrea-tic surgery: indications, technique, and outcome compared to standard pancreatic resections[J]. Langenbecks Arch Surg,2011,396(8):1197-1203.
[4] Guillemin P, Bessot M.Chronic calcifying pancreatitis in renal tuberculosis: pancreatojejunostomy using an original technic[J]. Mem Acad Chir (Paris),1957,83(27-28):869-871.
[5] Baca I, Bokan I.Laparoscopic segmental pancreas resection and pancreatic cystadenoma[J]. Chirurg,2003,74(10):961-965.
[6] Giulianotti PC, Sbrana F, Bianco FM, et al.Robot-assis-ted laparoscopic middle pancreatectomy[J]. J Laparoen-dosc Adv Surg Tech A,2010,20(2):135-139.
[7] Paiella S, De Pastena M, Faustini F, et al.Central pancreatectomy for benign or low-grade malignant pancreatic lesions - A single-center retrospective analysis of 116 cases[J]. Eur J Surg Oncol,2019,45(5):788-792.
[8] Chen S, Zhan Q, Jin J, et al.Robot-assisted laparoscopic versus open middle pancreatectomy: short-term results of a randomized controlled trial[J]. Surg Endosc,2017,31(2): 962-971.
[9] Du ZY, Chen S, Han BS, et al.Middle segmental pancreatectomy: a safe and organ-preserving option for benign and low-grade malignant lesions[J]. World J Gastroenterol,2013,19(9):1458-1465.
[10] Zhang RC, Zhang B, Mou YP, et al.Comparison of clinical outcomes and quality of life between laparoscopic and open central pancreatectomy with pancreaticojejunostomy[J]. Surg Endosc,2017,31:4756-4763.
[11] 施思, 项金峰, 徐近, 等. 2016版国际胰腺外科研究组术后胰瘘定义和分级系统更新内容介绍和解析[J]. 中国实用外科杂志,2017,37(2):149-152.
[12] Addeo P, Langella S, Arru L, et al.Robotic middle pancreatectomy with the double pursestring invaginated pancreaticogastrostomy(with video)[J]. J Visc Surg,2016, 153(6):475-476.
[13] Chirletti P, Peparini N, Caronna R, et al.Roux-en-Y end-to-end and end-to-side double pancreaticojejunostomy: application of the reconstructive method of the Beger procedure to central pancreatectomy[J]. Langenbecks Arch Surg,2010,395(1):89-93.
[14] Wente MN, Veit JA, Bassi C, et al.Postpancreatectomy hemorrhage (PPH)-An International Study Group of Pancreatic Surgery (ISGPS) definition[J]. Surgery,2007,142(1):20-25.
[15] Wang WG, Fu L, Babu SR, et al.Incidence of and risk factors and reinterventions for post-pancreatoduodenectomy hemorrhage: retrospective analysis[J]. Dig Surg,2018, 35(1):19-27.
[16] 沈柏用, 陈亚进, 彭兵, 等. 胰十二指肠切除术后出血的预防及处理[J]. 中华消化外科杂志,2018,17(7):682.
[17] 史瑞特, 沈柏用, 邓侠兴, 等. 胰十二指肠切除术后腹腔严重并发症发生的相关危险因素分析[J]. 外科理论与实践,2015,20(4):346-351.
[18] DiNorcia J, Ahmed L, Lee MK, et al. Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions[J]. Surgery,2010,148(6):1247-1254;discussion 1254-1256.
[19] Cataldegirmen G, Schneider CG, Bogoevski D, et al.Extended central pancreatic resection as an alternative for extended left or extended right resection for appropriate pancreatic neoplasms[J]. Surgery,2010,147(3):331-338.
[20] Du ZY, Chen S, Han BS, et al.Middle segmental pancreatectomy: a safe and organ-preserving option for benign and low-grade malignant lesions[J]. World J Gastroenterol,2013,19(9):1458-1465.
[21] Song KB, Kim SC, Park KM, et al.Laparoscopic central pancreatectomy for benign or low-grade malignant lesions in the pancreatic neck and proximal body[J]. Surg Endosc,2015,29(4):937-946.
[22] Dokmak S, Ftériche FS, Aussilhou B, et al.The largest European single-center experience: 300 laparoscopic pancreatic resections[J]. J Am Coll Surg,2017,225(2): 226-234.
[23] Xu SB, Zhu YP, Zhou W, et al.Patients get more long-term benefit from central pancreatectomy than distal resection: a meta-analysis[J]. Eur J Surg Oncol,2013,39(6):567-574.
[24] Iacono C,Verlato G, Ruzzenente A, et al.Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy[J]. Br J Surg,2013,100(7):873-885.
[25] Xiao W, Zhu J, Peng L, et al.The role of central pancreatectomy in pancreatic surgery: a systematic review and meta-analysis[J]. HPB (Oxford),2018,20(10):896-904.
[26] Muller MW, Friess H, Kleeff J, et al. Middle segmental pancreatic resection: An option to treat benign pancreatic body lesions[J]. Ann Surg,2006,244(6):909-918;discussion 918-920.
[27] Iacono C, Bortolasi L, Serio G.Indications and technique of central pancreatectomy-early and late results[J]. Langenbecks Arch Surg,2005,390(3):266-271.
[28] Christein JD, Smoot RL, Farnell MB.Central pancreate-ctomy: a technique for the resection of pancreatic neck lesions[J]. Arch Surg,2006,141(3):293-299.
[29] Crippa S, Bassi C, Warshaw AL, et al.Middle pancreatectomy: indications, short and long-term operative outcomes[J]. Ann Surg,2007,246(1):69-76.
[30] Allendorf JD, Schrope BA, Lauerman MH, et al. Postoperative glycemic control after central pancreatectomy for mid-gland lesions[J]. World J Surg,2007,31(1):164-168;discussion 169-170.
[31] Hirono S, Tani M, Kawai M, et al.A central pancreatectomy for benign or low-grade malignant neoplasms[J]. J Gastrointest Surg,2009,13(9):1659-1665.
[32] Han GJ, Kim S, Lee NK, et al.Prediction of late posto-perative hemorrhage after whipple procedure using computed tomography performed during early postoperative period[J]. Korean J Radiol,2018,19(2):284-291.
[33] Magge D, Zenati M, Lutfi W, et al.Robotic pancreatoduodenectomy at an experienced institution is not associated with an increased risk of post-pancreatic hemorrhage[J]. HPB (Oxford),2018,20(5):448-455.
[34] Wolk S, Grützmann R, Rahbari NN, et al.Management of clinically relevant postpancreatectomy hemorrhage (PPH) over two decades - A comparative study of 1 450 consecutive patients undergoing pancreatic resection[J]. Pancreatology,2017,17(6):943-950.
[35] Crippa S, Tamburrino D, Partelli S, et al.Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes[J]. Surgery,2011,149(1):79-86.
[36] Mathur A, Ross SB, Luberice K, et al.Margin status impacts survival after pancreaticoduodenectomy but negative margins should not be pursued[J]. Am Surg,2014,80(4):353-360.
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