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Surgical, survival, and oncological outcomes after vascular resection in robotic and open pancreaticoduodenectomy

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Abstract

Background

To evaluate the surgical, oncological, and survival outcomes after pancreaticoduodenectomy (PD) with superior mesenteric vein (SMV)/portal vein (PV) resection by either robotic PD (RPD) or open PD (OPD).

Methods

Data of patients with periampullary lesions undergoing PD were retrieved from a prospectively collected computer database. Surgical risks as well as oncological and survival outcomes were compared between patients with (vein resection group) and without SMV/PV resection (without vein resection group).

Results

A total of 391 patients undergoing pancreaticoduodenectomy were enrolled, including 43 (11.0%) and 384 (89.0%) patients with and without vein resection, respectively. Eleven (25.6%) of PDs with vein resection were performed using the robotic approach. Operation time in the vein resection group was significantly longer (median of 8 vs. 7 h). Blood loss, curative resection (R0) rate, and harvested lymph node number were similar between these two groups. Surgical outcomes including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), chyle leakage, wound infection, and hospital stay were not significantly different between the two groups. There was no survival difference between these groups, with 1- and 3-year survival rates of 92.6% and 26.5%, respectively, for vein resection group, vs. 70.3% and 37.2%, respectively, for the without vein resection group.

Conclusions

PD with vein resection is technically feasible by OPD and RPD in selected patients. Additional SMV/PV would not increase the surgical risks of PD and could achieve similar survival outcomes for pancreatic head adenocarcinoma when compared to PD without vein resection.

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Acknowledgements

This work was financially supported by grants from the Taipei Veterans General Hospital (V106C-028, VTA106-V1-1-1), the Ministry of Science and Technology (MOST 106-2314-B-075-048-MY2), and the Ministry of Health and Welfare (MOHW107-TDU-B-212-114026A).

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Authors and Affiliations

  1. Departments of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan

    Bor-Uei Shyr, Shih-Chin Chen, Yi-Ming Shyr & Shin-E Wang

  2. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Section 2 Shipai Road, Taipei, 112, Taiwan

    Shin-E Wang

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Bor-Uei Shyr, Shih-Chin Chen, Yi-Ming Shyr, and Shin-E Wang have no conflicts of interest or financial ties to disclose.

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Shyr, BU., Chen, SC., Shyr, YM. et al. Surgical, survival, and oncological outcomes after vascular resection in robotic and open pancreaticoduodenectomy. Surg Endosc 34, 377–383 (2020). https://doi.org/10.1007/s00464-019-06779-x

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