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Surgical Endoscopy

, Volume 29, Issue 12, pp 3507–3518 | Cite as

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

  • Shi Chen
  • Qian Zhan
  • Jiang-zhi Chen
  • Jia-bin Jin
  • Xia-xing Deng
  • Hao Chen
  • Bai-yong ShenEmail author
  • Cheng-hong PengEmail author
  • Hong-wei Li
Article

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.

Keywords

Laparoscopic distal pancreatectomy Spleen preservation Robotic assistance Minimal invasiveness Matched cohort study 

Notes

Acknowledgments

The authors thank all of the participating patients and their families, as well as investigators, research nurses, study coordinators, and operation staff. Cheng-hong Peng and Bai-yong Shen designed the study protocol and reviewed the manuscript.

Disclosures

Authors Shi Chen, Qian Zhan, Jiang-zhi Chen, Jia-bin Jin, Xia-xing Deng, Hao Chen, Bai-yong Shen, Cheng-hong Peng, and Hong-wei Li have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Shi Chen
    • 1
    • 2
  • Qian Zhan
    • 1
  • Jiang-zhi Chen
    • 1
    • 3
  • Jia-bin Jin
    • 1
  • Xia-xing Deng
    • 1
  • Hao Chen
    • 1
  • Bai-yong Shen
    • 1
    Email author
  • Cheng-hong Peng
    • 1
    Email author
  • Hong-wei Li
    • 1
  1. 1.Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive SurgeryRuijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Department of Hepatobiliary Surgery, Fujian Provincial HospitalFujian Medical UniversityFuzhouPeople’s Republic of China
  3. 3.Department of Hepatobiliary Surgery, Union HospitalFujian Medical UniversityFuzhouPeople’s Republic of China

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