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Comparison of Perioperative Outcomes between Open, Laparoscopic, and Robotic Distal Pancreatectomy: an Analysis of 1815 Patients from the ACS-NSQIP Procedure-Targeted Pancreatectomy Database

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Robotic surgery is gaining acceptance for distal pancreatectomy (DP). Nevertheless, no multi-institutional data exist to demonstrate the ideal clinical circumstances for use and the efficacy of the robot compared to the open or laparoscopic techniques, in terms of perioperative outcomes.

Methods

The 2014 ACS-NSQIP procedure-targeted pancreatectomy data for patients undergoing DP were analyzed. Demographics and clinicopathological and perioperative variables were compared between the three approaches. Univariate and multivariable analyses were used to evaluate outcomes.

Results

One thousand eight hundred fifteen DPs comprised 921 open distal pancreatectomies (ODPs), 694 laparoscopic distal pancreatectomies (LDPs), and 200 robotic distal pancreatectomies (RDPs). The three groups were comparable with respect to demographics, ASA score, relevant comorbidities, and malignant histology subtype. Compared to the ODP group, patients undergoing RDP had lower T-stages of disease (P = 0.0192), longer operations (P = 0.0030), shorter hospital stays (P < 0.0001), and lower postoperative 30-day morbidity (P = 0.0476). Compared to the LDP group, RDPs were longer operations (P < 0.0001) but required fewer concomitant vascular resections (P = 0.0487) and conversions to open surgery (P = 0.0068). On multivariable analysis, neoadjuvant therapy (P = 0.0236), malignant histology (P = 0.0124), pancreatic reconstruction (P = 0.0006), and vascular resection (P = 0.0008) were the strongest predictors of performing an ODP.

Conclusions

The open, laparoscopic, and robotic approaches to distal pancreatectomy offer particular advantages for well-selected patients and specific clinicopathological contexts; therefore, clearly demonstrating the most suitable use and superiority of one technique over another remains challenging.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02215, USA

    Dimitrios Xourafas, Stanley W. Ashley & Thomas E. Clancy

Authors
  1. Dimitrios Xourafas
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  2. Stanley W. Ashley
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  3. Thomas E. Clancy
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Contributions

Dimitrios Xourafas, Stanley W. Ashley, and Thomas E. Clancy contributed to the design of the work; acquisition, analysis, interpretation of data, drafting or revising the work critically. All coauthors have approved the final version of the manuscript and are accountable for all aspects of the work.

Corresponding author

Correspondence to Dimitrios Xourafas.

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The authors declare that they have no conflict of interest.

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Xourafas, D., Ashley, S.W. & Clancy, T.E. Comparison of Perioperative Outcomes between Open, Laparoscopic, and Robotic Distal Pancreatectomy: an Analysis of 1815 Patients from the ACS-NSQIP Procedure-Targeted Pancreatectomy Database. J Gastrointest Surg 21, 1442–1452 (2017). https://doi.org/10.1007/s11605-017-3463-5

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  • DOI: https://doi.org/10.1007/s11605-017-3463-5

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