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Resection or repair of large peripancreatic arteries during robotic pancreatectomy

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Abstract

Minimally invasive pancreatic surgery is eventually gaining momentum, but concerns remain regarding the ability to manage challenging operative scenarios. A retrospective review of a prospectively maintained database was performed to identify patients who received arterial resection, or required arterial repair, during robot-assisted pancreatic resection (RA-PR). All procedures were video recorded. Between October 2008 and June 2019, a total of 361 RA-PR were performed. Associated vascular procedures were required in 31 patients (8.5%), including resection or repair of arterial segments in five cases (1.3%): celiac trunk (n = 1), hepatic artery (n = 2), splenic artery (n = 1), and superior mesenteric artery (n = 1). In three patients, an arterial resection was required to manage tumor infiltration. In the remaining two patients, an intraoperative injury demanded arterial repair. All procedures were completed without conversion to open surgery and no patient developed severe complications. At the longest follow-up, all vascular reconstructions are patent. Our results do not call for more liberal use of robotic assistance in borderline resectable or locally advanced pancreatic tumors, but rather emphasize the importance of proper preoperative planning and the need for advanced vascular skills for safe implementation of RA-PR.

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References

  1. Klompmaker S, van Hilst J, Wellner UF et al (2018) Outcomes after minimally-invasive versus open pancreatoduodenectomy. Ann Surg. https://doi.org/10.1097/sla.0000000000002850

    Article  Google Scholar 

  2. van Hilst J, de Rooij T, Klompmaker S et al (2019) Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA). Ann Surg 269:10–17. https://doi.org/10.1097/sla.0000000000002561

    Article  PubMed  Google Scholar 

  3. Dokmak S, Aussilhou B, Ftériche FS et al (2014) Pure laparoscopic middle pancreatectomy: single-center experience with 13 cases. Surg Endosc 28:1601–1606. https://doi.org/10.1007/s00464-013-3357-x

    Article  PubMed  Google Scholar 

  4. Zhang RC, Zhou YC, Mou YP et al (2016) Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis. Surg Endosc 30:2657–2665. https://doi.org/10.1007/s00464-015-4538-6

    Article  PubMed  Google Scholar 

  5. Fan CJ, Hirose K, Walsh CM et al (2017) Laparoscopic total pancreatectomy with islet autotransplantation and intraoperative islet separation as a treatment for patients with chronic pancreatitis. JAMA Surg 152:550–556. https://doi.org/10.1001/jamasurg.2016.5707

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kleive D, Sahakyan MA, Khan A et al (2018) Incidence and management of arterial injuries during pancreatectomy. Langenbeck’s Arch Surg 403:341–348. https://doi.org/10.1007/s00423-018-1666-1

    Article  Google Scholar 

  7. van Hilst J, De Rooij T, Bosscha K et al (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4:199–207. https://doi.org/10.1016/S2468-1253(19)30004-4

    Article  PubMed  Google Scholar 

  8. Kim KS, Kwon J, Kim K, Chie EK (2017) Impact of resection margin distance on survival of pancreatic cancer: a systematic review and meta-analysis. Cancer Res Treat 49:824–833. https://doi.org/10.4143/crt.2016.336

    Article  PubMed  Google Scholar 

  9. Eskander MF, de Geus SWL, Kasumova GG et al (2017) Evolution and impact of lymph node dissection during pancreaticoduodenectomy for pancreatic cancer. Surgery (United States) 161:968–976. https://doi.org/10.1016/j.surg.2016.09.032

    Article  Google Scholar 

  10. Chandra V, Nehra D, Parent R et al (2010) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 147:830–839. https://doi.org/10.1016/j.surg.2009.11.002

    Article  PubMed  Google Scholar 

  11. Gavriilidis P, Lim C, Menahem B et al (2016) Robotic versus laparoscopic distal pancreatectomy—the first meta-analysis. HPB 18:567–574. https://doi.org/10.1016/j.hpb.2016.04.008

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chen S, Zhan Q, Chen J et al (2015) Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc 29:3507–3518. https://doi.org/10.1007/s00464-015-4101-5

    Article  PubMed  Google Scholar 

  13. Boggi U, Del Chiaro M, Croce C et al (2009) Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery 146:869–881. https://doi.org/10.1016/j.surg.2009.04.029

    Article  PubMed  Google Scholar 

  14. Boggi U, Napoli N, Costa F et al (2016) Robotic-Assisted Pancreatic Resections. World J Surg 40:2497–2506. https://doi.org/10.1007/s00268-016-3565-3

    Article  PubMed  Google Scholar 

  15. Napoli N, Kauffmann EF, Menonna F et al (2016) Indications, technique, and results of robotic pancreatoduodenectomy. Updates Surg 68:295–305. https://doi.org/10.1007/s13304-016-0387-7

    Article  PubMed  Google Scholar 

  16. Kauffmann EF, Napoli N, Menonna F et al (2016) Robotic pancreatoduodenectomy with vascular resection. Langenbeck’s Arch Surg 401:1111–1122. https://doi.org/10.1007/s00423-016-1499-8

    Article  Google Scholar 

  17. Napoli N, Kauffmann EF, Perrone VG et al (2015) The learning curve in robotic distal pancreatectomy. Updates Surg 67:257–264. https://doi.org/10.1007/s13304-015-0299-y

    Article  PubMed  Google Scholar 

  18. Napoli N, Kauffmann EF, Palmeri M et al (2016) The learning curve in robotic pancreaticoduodenectomy. Dig Surg 33:299–307. https://doi.org/10.1159/000445015

    Article  CAS  PubMed  Google Scholar 

  19. Klompmaker S, Boggi U, Hackert T et al (2018) Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer. How i do it. J Gastrointest Surg 22:1804–1810. https://doi.org/10.1007/s11605-018-3894-7

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery (United States) 161:584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  Google Scholar 

  22. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–768. https://doi.org/10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  23. Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH)-an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25. https://doi.org/10.1016/j.surg.2007.02.001

    Article  PubMed  Google Scholar 

  24. Slankamenac K, Graf R, Barkun J et al (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7. https://doi.org/10.1097/SLA.0b013e318296c732

    Article  PubMed  Google Scholar 

  25. Kasumova GG, Conway WC, Tseng JF (2018) The role of venous and arterial resection in pancreatic cancer surgery. Ann Surg Oncol 25:51–58. https://doi.org/10.1245/s10434-016-5676-3

    Article  PubMed  Google Scholar 

  26. Tempero MA, Malafa MP, Al-Hawary M et al (2017) Pancreatic adenocarcinoma, version 2.2017: clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15:1028–1061. https://doi.org/10.6004/jnccn.2017.0131

    Article  Google Scholar 

  27. Tee MC, Krajewski AC, Groeschl RT et al (2018) Indications and perioperative outcomes for pancreatectomy with arterial resection. J Am Coll Surg 227:255–269. https://doi.org/10.1016/j.jamcollsurg.2018.05.001

    Article  PubMed  Google Scholar 

  28. Cho A, Yamamoto H, Kainuma O et al (2011) Pure laparoscopic distal pancreatectomy with en bloc celiac axis resection. J Laparoendosc Adv Surg Tech. https://doi.org/10.1089/lap.2011.0300

    Article  Google Scholar 

  29. Giulianotti PC, Addeo P, Buchs NC et al (2011) Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas. https://doi.org/10.1097/MPA.0b013e318220e3a4

    Article  PubMed  Google Scholar 

  30. Ocuin LM, Miller-Ocuin JL, Novak SM et al (2016) Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: a single institutional assessment of perioperative outcomes and survival. HPB 18:835–842. https://doi.org/10.1016/j.hpb.2016.05.003

    Article  PubMed  PubMed Central  Google Scholar 

  31. Stiles ZE, Dickson PV, Deneve JL et al (2018) The impact of unplanned conversion to an open procedure during minimally invasive pancreatectomy. J Surg Res 227:168–177. https://doi.org/10.1016/j.jss.2018.02.028

    Article  PubMed  Google Scholar 

  32. Palanisamy S, Deuri B, Naidu SB et al (2016) Hepatic artery reconstruction following iatrogenic injury during laparoscopic distal pancreatectomy: minimal access surgery is new horizon. J Minim Access Surg 12:382–384. https://doi.org/10.4103/0972-9941.181330

    Article  PubMed  PubMed Central  Google Scholar 

  33. Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825. https://doi.org/10.1056/NEJMoa1011923

    Article  CAS  PubMed  Google Scholar 

  34. Boggi U, Signori S, Vistoli F et al (2012) Laparoscopic robot-assisted pancreas transplantation: first world experience. Transplantation 93:201–206. https://doi.org/10.1097/TP.0b013e318238daec

    Article  PubMed  Google Scholar 

  35. Boggi U, Belluomini MA, Barbarello L et al (2015) Laparoscopic robot-assisted distal splenorenal shunt. Surgery (United States) 157:405. https://doi.org/10.1016/j.surg.2014.07.012

    Article  Google Scholar 

  36. Boggi U, Vistoli F, Signori S et al (2011) Robotic renal transplantation: first European case. Transpl Int 24:213–218. https://doi.org/10.1111/j.1432-2277.2010.01191.x

    Article  PubMed  Google Scholar 

  37. Ceppa EP, McCurdy RM, Becerra DC et al (2015) Does pancreatic stump closure method influence distal pancreatectomy outcomes? J Gastrointest Surg 19:1449–1456. https://doi.org/10.1007/s11605-015-2825-0

    Article  PubMed  Google Scholar 

  38. Al-Hawary MM, Francis IR, Chari ST et al (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the American pancreatic association. Gastroenterology 146:291–304. https://doi.org/10.1053/j.gastro.2013.11.004

    Article  PubMed  Google Scholar 

  39. Brook OR, Brook A, Vollmer CM et al (2015) Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning. Radiology 274:464–472. https://doi.org/10.1148/radiol.14140206

    Article  PubMed  Google Scholar 

  40. Mugunthan NP, Kannan R, Jebakani CF, Anbalagan J (2016) Variations in the origin and course of right hepatic artery and its surgical significance. J Clin Diagnostic Res 10:AC01–AC04. https://doi.org/10.7860/JCDR/2016/22126.8428

    Article  Google Scholar 

  41. Rosemurgy A, Ross S, Bourdeau T et al (2019) Robotic pancreaticoduodenectomy is the future: here and now. J Am Coll Surg 228:613–624. https://doi.org/10.1016/j.jamcollsurg.2018.12.040

    Article  PubMed  Google Scholar 

  42. Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402. https://doi.org/10.1007/s00464-012-2207-6

    Article  CAS  PubMed  Google Scholar 

  43. Di Paolo M, Boggi U, Turillazzi E (2019) Bioethical approach to robot-assisted surgery. Br J Surg 106:1271–1272. https://doi.org/10.1002/bjs.11288

    Article  PubMed  Google Scholar 

  44. Yang F, Wang X, Jin C, He H, Fu D (2019) Pancreatectomy with hepatic artery resection for pancreatic head cancer. World J Surg 43:2909–2919. https://doi.org/10.1007/s00268-019-05106-8

    Article  PubMed  Google Scholar 

  45. Miura F, Asano T, Amano H et al (2010) Eleven cases of postoperative hepatic infarction following pancreato-biliary surgery. J Gastrointest Surg 14:352–358. https://doi.org/10.1007/s11605-009-1089-y

    Article  PubMed  Google Scholar 

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Emanuele F. Kauffmann, Niccolò Napoli, Concetta Cacace, Francesca Menonna, Fabio Vistoli & Ugo Boggi

  2. Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

    Gabriella Amorese

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  1. Emanuele F. Kauffmann
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  2. Niccolò Napoli
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Contributions

Substantial contributions were made to the conception or design of the work (EFK and UB), the acquisition, analysis (EFK, NN and CC), interpretation of data for the work (EFK and UB), drafting the work (EFK, UB, NN, FV, CC and GA) or revising it critically for important intellectual content (EFK, UB, NN, FV, CC and GA), and final approval of the version to be published (EFK, UB, NN, FV, CC and GA). Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (EFK, UB, NN, FV, CC and GA).

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Correspondence to Emanuele F. Kauffmann.

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Kauffmann, E.F., Napoli, N., Cacace, C. et al. Resection or repair of large peripancreatic arteries during robotic pancreatectomy. Updates Surg 72, 145–153 (2020). https://doi.org/10.1007/s13304-020-00715-8

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