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

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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.

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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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    Authors and Affiliations

    1. Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People’s Republic of China

      Shi Chen, Qian Zhan, Jiang-zhi Chen, Jia-bin Jin, Xia-xing Deng, Hao Chen, Bai-yong Shen, Cheng-hong Peng & Hong-wei Li

    2. Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, People’s Republic of China

      Shi Chen

    3. Department of Hepatobiliary Surgery, Union Hospital, Fujian Medical University, Fuzhou, People’s Republic of China

      Jiang-zhi Chen

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    1. Shi Chen
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    Correspondence to Bai-yong Shen or Cheng-hong Peng.

    Additional information

    Shi Chen and Qian Zhan contributed equally to this work, and both should be considered first author.

    Bai-yong Shen and Cheng-hong Peng also contributed equally, and both should be considered as co-corresponding author.

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    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. Surg Endosc 29, 3507–3518 (2015). https://doi.org/10.1007/s00464-015-4101-5

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    • DOI: https://doi.org/10.1007/s00464-015-4101-5

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