Robotic versus laparoscopic distal pancreatectomy for pancreatic adenocarcinoma in obese patients

Fabio Ausania; Filippo Landi; Carolina González-Abós; John B Martinie; Dionisios Vrochides; Matthew Walsh; Shanaz M Hossain; Steven White; Viswakumar Prabakaran; Laleh G Melstrom; Yuman Fong; Valentina Valle; Yuntao Bing; Dianrong Xiu; Gregorio Di Franco; Nicola De' Angelis; Alexis Laurent; Giuseppe Giuliani; Graziano Pernazza; Riccardo Memeo; José Rios; Andrea Coratti; Luca Morelli; Pier C Giulianotti

doi:10.1002/rcs.2596

Robotic versus laparoscopic distal pancreatectomy for pancreatic adenocarcinoma in obese patients

Int J Med Robot. 2023 Nov 8:e2596. doi: 10.1002/rcs.2596. Online ahead of print.

Authors

Fabio Ausania¹, Filippo Landi¹, Carolina González-Abós¹, John B Martinie², Dionisios Vrochides², Matthew Walsh³, Shanaz M Hossain³, Steven White⁴, Viswakumar Prabakaran⁴, Laleh G Melstrom⁵, Yuman Fong⁵, Valentina Valle⁶, Yuntao Bing⁷, Dianrong Xiu⁷, Gregorio Di Franco⁸, Nicola De' Angelis⁹, Alexis Laurent⁹, Giuseppe Giuliani¹⁰, Graziano Pernazza¹¹, Riccardo Memeo¹², José Rios¹³, Andrea Coratti¹⁰, Luca Morelli⁸, Pier C Giulianotti⁶

Affiliations

¹ Department of HBP Surgery and Transplantation, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.
² Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
³ HPB Surgery Department, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Freeman Hospital, NHS, Newcastle-Upon-Tyne, UK.
⁵ Division of Surgical Oncology, Gastrointestinal Disease Team, City of Hope Medical Center, Duarte, California, USA.
⁶ Department of Surgery, Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
⁷ Department of General Surgery, Beijing Third Hospital, Beijing, China.
⁸ Division of Translational and New Technologies in Medicine and Surgery, General Surgery Department, University of Pisa, Pisa, Italy.
⁹ Department of Digestive, HBP Surgery and Liver Transplantation, Henri Mondor Hospital, APHP, Creteil, France.
¹⁰ Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy.
¹¹ General and Robotic Surgery Department, San Giovanni Hospital, Rome, Italy.
¹² Department of Surgery, Acquaviva delle Fonti Hospital, Bari, Italy.
¹³ Department of Clinical Pharmacology, Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.

PMID: 37937476
DOI: 10.1002/rcs.2596

Abstract

Background: Robotic distal pancreatectomy (RDP) is associated with a lower conversion rate and less blood loss than laparoscopic distal pancreatectomy (LDP). LDP has similar oncological outcomes as open surgery in PDAC. The aim of this study was to compare perioperative and oncological outcomes in obese patients with RDP versus LDP for PDAC.

Materials and methods: Retrospectively, all obese patients who underwent RDP or LDP for PDAC between 2012 and 2022 at 12 international expert centres were included.

Results: out of 372, 81 patients were included. All baseline features were comparable between the two groups. RDP was associated with decreased blood loss (495mlLDP vs. 188mlRDP; p = 0.003), lower conversion rate (13.5%RDP vs. 36.4%LDP; p = 0.019) and lower rate of Clavien-Dindo ≥3 complications (13.5%RDP vs. 36.4%LDP; p = 0.019). Overall and disease-free survival were comparable.

Conclusions: In obese patients with left-sided PDAC, the robotic approach was associated with improved intraoperative outcomes and fewer severe complications.

Keywords: PDAC; distal pancreatectomy; obese patients; robotic surgery.