Background: The aim of this study was to determine the feasibility, safety, and rate of postoperative complications after robot-assisted middle pancreatectomy compared with open middle pancreatectomy.
Methods: This retrospective study was conducted in Shanghai Ruijin Hospital, China, involving 170 patients who underwent robot-assisted middle pancreatectomy or open middle pancreatectomy from December 2010 to December 2017. Patients were in 1 of 2 groups: robot-assisted middle pancreatectomy (n = 110) and open middle pancreatectomy (n = 60).
Results: Among the 110 patients who underwent robot-assisted middle pancreatectomy, age, operation time, blood loss, and tumor size were 47 ± 14 y, 162 ± 63 min, 88 ± 93 mL, and 2.4±1.3 cm (mean ± standard deviation), respectively. Among the 60 patients who underwent open middle pancreatectomy, age, operation time, blood loss, and tumor size were 53 ± 14 y, 208 ± 52 min, 195 ± 165 mL, and 2.5 ± 1.4 cm (mean ± standard deviation), respectively. Mean operation time and blood loss were less in the robot-assisted middle pancreatectomy group (P < .001 each). Overall morbidity rate in the robot-assisted middle pancreatectomy group was 51.8% and 40% in open middle pancreatectomy group (P = .140). Clinically relevant postoperative pancreatic fistulas developed in 38 (34.5%) patients in the robot-assisted middle pancreatectomy group and 13 (22%) in the open middle pancreatectomy group (P = .105). A total of 10 patients in the robot-assisted middle pancreatectomy group and 3 patients in the open middle pancreatectomy group required a reoperation or angiographic embolization because of postoperative bleeding. The mean hospital stay was similar in the 2 groups (25 ± 13 d versus and 24 ± 18 d). There was 1 postoperative death in each group because of postoperative bleeding and a pulmonary embolus, respectively. The tumors in this study included 65 serous cystic neoplasms, 6 mucinous cystic neoplasms, 35 intraductal papillary mucinous neoplasms, 29 pancreatic neuroendocrine tumors, 31 solid pseudopapillary tumors, 1 paraganglioma, and 3 pancreatic cysts.
Conclusion: Middle pancreatectomy is a safe and effective robotic operative procedure, and when possible, robot-assisted middle pancratectomy might be the preferred method, because it was associated with decreased operative time and decreased blood loss. The lesser operation time might be attributed to different reconstruction methods that were chosen in the open and robotic approach. Pancreatic fistula remains the major complication.
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