nach oben

Erschienen in:

04.05.2019 | Original Article

Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study

verfasst von: Sergio Alfieri, Giovanni Butturini, Ugo Boggi, Andrea Pietrabissa, Luca Morelli, Fabio Vistoli, Isacco Damoli, Andrea Peri, Claudio Fiorillo, Luigi Pugliese, Marco Ramera, Nelide De Lio, Gregorio Di Franco, Alessandro Esposito, Luca Landoni, Fausto Rosa, Roberta Menghi, Giovanni Battista Doglietto, Giuseppe Quero, The Italian Robotic pNET Group

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Minimally invasive surgery has increasingly gained popularity as a treatment of choice for pancreatectomy with encouraging initial results in robotic distal pancreatectomy (RDP). However, few data are available on the comparison between RDP and laparoscopic distal pancreatectomy (LDP) for pancreatic neuroendocrine tumors (pNETs). Our aim, thus, is to compare perioperative and long-term outcomes as well as total costs of RDP and LDP for pNETs.

Methods

All RDPs and LDPs for pNETs performed in four referral centers from 2008 to 2016 were included. Perioperative outcomes, histopathological results, overall (OS) and disease-free survival (DFS), and total costs were evaluated.

Results

Ninety-six RDPs and 85 LDPs were included. Demographic and clinical characteristics were comparable between the two cohorts. Operative time was 36.5 min longer in the RDP group (p = 0.009) but comparable to LDP after removing the docking time (247.9 vs 233.7 min; p = 0.6). LDP related to a lower spleen preservation rate (44.7% vs 65.3%; p < 0.0001) and higher blood loss (239.7 ± 112 vs 162.5 ± 98 cc; p < 0.0001). Advantages in operative time for RDP were documented in case of the spleen preservation procedures (265 ± 41.52 vs 291 ± 23 min; p = 0.04). Conversion rate, postoperative morbidity, and pancreatic fistula rate were similar between the two groups, as well as histopathological data, OS, and DFS. Significant advantages were evidenced for LDP regarding mean total costs (9235 (± 1935) € vs 11,226 (± 2365) €; p < 0.0001).

Conclusions

Both RDP and LDP are safe and efficacious for pNETs treatment. However, RDP offers advantages with a higher spleen preservation rate and lower blood loss. Costs still remain the main limitation of the robotic approach.

Hill JS, McPhee JT, McDade TP, Zhou Z, Sullivan ME, Whalen GF, Tseng JF (2009) Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer 115(4):741–751. https://doi.org/10.1002/cncr.24065 CrossRefPubMed

Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120(6):1051–1054CrossRefPubMed

Antonakis PT, Ashrafian H, Martinez-Isla A (2015) Pancreatic insulinomas: laparoscopic management. World J Gastrointest Endosc 7(16):1197–1207. https://doi.org/10.4253/wjge.v7.i16.1197 CrossRefPubMedPubMedCentral

Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8(4):493–501. https://doi.org/10.1016/j.gassur.2003.11.014 CrossRefPubMed

Liu H, Peng C, Zhang S, Wu Y, Fang H, Sheng H, Peng S (2007) Strategy for the surgical management of insulinomas: analysis of 52 cases. Dig Surg 24(6):463–470. https://doi.org/10.1159/000111822 CrossRefPubMed

Sa Cunha A, Beau C, Rault A, Catargi B, Collet D, Masson B (2007) Laparoscopic versus open approach for solitary insulinoma. Surg Endosc 21(1):103–108. https://doi.org/10.1007/s00464-006-0021-8 CrossRefPubMed

Fernandez Ranvier GG, Shouhed D, Inabnet WB 3rd (2016) Minimally invasive techniques for resection of pancreatic Neuroendocrine tumors. Surg Oncol Clin N Am 25(1):195–215. https://doi.org/10.1016/j.soc.2015.08.009 CrossRefPubMed

Melvin WS, Needleman BJ, Krause KR, Schneider C, Wolf RK, Michler RE, Ellison EC (2002) Computer-enhanced robotic telesurgery. Initial experience in foregut surgery. Surg Endosc 16(12):1790–1792. https://doi.org/10.1007/s00464-001-8192-9 CrossRefPubMed

Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ (2013) Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 257(1):128–132. https://doi.org/10.1097/SLA.0b013e31825fff08 CrossRefPubMed

10.

Chen S, Zhan Q, Chen JZ, Jin JB, Deng XX, Chen H, Shen BY, Peng CH, Li HW (2015) Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc 29(12):3507–3518. https://doi.org/10.1007/s00464-015-4101-5 CrossRefPubMed

11.

Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, Caravaglios G, Coratti A (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24(7):1646–1657. https://doi.org/10.1007/s00464-009-0825-4 CrossRefPubMed

12.

Kang CM, Kim DH, Lee WJ, Chi HS (2011) Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 25(6):2004–2009. https://doi.org/10.1007/s00464-010-1504-1 CrossRefPubMed

13.

Lai EC, Tang CN (2013) Current status of robot-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a comprehensive review. Asian J Endosc Surg 6(3):158–164. https://doi.org/10.1111/ases.12040 CrossRefPubMed

14.

Lee SY, Allen PJ, Sadot E, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Kingham TP (2015) Distal pancreatectomy: a single institution's experience in open, laparoscopic, and robotic approaches. J Am Coll Surg 220(1):18–27. https://doi.org/10.1016/j.jamcollsurg.2014.10.004 CrossRefPubMed

15.

Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Lillemoe KD, Schmidt CM (2010) Robotic distal pancreatectomy: cost effective? Surgery 148(4):814–823. https://doi.org/10.1016/j.surg.2010.07.027 CrossRefPubMed

16.

Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258(4):554–559; discussion 559-562. https://doi.org/10.1097/SLA.0b013e3182a4e87c CrossRefPubMedPubMedCentral

17.

Melvin WS, Needleman BJ, Krause KR, Ellison EC (2003) Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A 13(1):33–36. https://doi.org/10.1089/109264203321235449 CrossRefPubMed

18.

Falconi M, Plockinger U, Kwekkeboom DJ, Manfredi R, Korner M, Kvols L, Pape UF, Ricke J, Goretzki PE, Wildi S, Steinmuller T, Oberg K, Scoazec JY, Frascati Consensus C, European Neuroendocrine Tumor S (2006) Well-differentiated pancreatic nonfunctioning tumors/carcinoma. Neuroendocrinology 84(3):196–211. https://doi.org/10.1159/000098012 CrossRefPubMed

19.

Falconi M, Bartsch DK, Eriksson B, Kloppel G, Lopes JM, O'Connor JM, Salazar R, Taal BG, Vullierme MP, O'Toole D, Conference p BC (2012) ENETS Consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology 95(2):120–134. https://doi.org/10.1159/000335587 CrossRefPubMed

20.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMed

21.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula D (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13. https://doi.org/10.1016/j.surg.2005.05.001 CrossRef

22.

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Buchler MW (2007) Postpancreatectomy hemorrhage (PPH): an international study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25. https://doi.org/10.1016/j.surg.2007.02.001 CrossRefPubMed

23.

Bosman FTCF, Hruban RH (2010) WHO classification of tumours of the digestive system. International Agency for Research on Cancer (IARC), Lyon

24.

Kloppel G, Rindi G, Perren A, Komminoth P, Klimstra DS (2010) The ENETS and AJCC/UICC TNM classifications of the neuroendocrine tumors of the gastrointestinal tract and the pancreas: a statement. Virchows Arch 456(6):595–597. https://doi.org/10.1007/s00428-010-0924-6 CrossRefPubMed

25.

Ayav A, Bresler L, Brunaud L, Boissel P, Sfcl, Afce (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbeck's Arch Surg 390(2):134–140. https://doi.org/10.1007/s00423-004-0526-3 CrossRef

26.

Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22(10):2261–2268. https://doi.org/10.1007/s00464-008-9973-1 CrossRefPubMed

27.

Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123(5):550–553CrossRefPubMed

28.

Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137(2):164–168CrossRefPubMed

29.

Baldwin KM, Katz SC, Espat NJ, Somasundar P (2011) Laparoscopic spleen-preserving distal pancreatectomy in elderly subjects: splenic vessel sacrifice may be associated with a higher rate of splenic infarction. HPB (Oxford) 13(9):621–625. https://doi.org/10.1111/j.1477-2574.2011.00341.x CrossRef

30.

Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246(1):77–82. https://doi.org/10.1097/01.sla.0000258607.17194.2b CrossRefPubMedPubMedCentral

31.

Zhou W, Lv R, Wang X, Mou Y, Cai X, Herr I (2010) Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg 200(4):529–536. https://doi.org/10.1016/j.amjsurg.2009.12.022 CrossRefPubMed

32.

Tamburrino D, Partelli S, Renzi C, Crippa S, Muffatti F, Perali C, Parisi A, Randolph J, Fusai GK, Cirocchi R, Falconi M (2017) Systematic review and meta-analysis on laparoscopic pancreatic resections for neuroendocrine neoplasms (PNENs). Expert Rev Gastroenterol Hepatol 11(1):65–73. https://doi.org/10.1080/17474124.2017.1253473 CrossRefPubMed

33.

Strijker M, van Santvoort HC, Besselink MG, van Hillegersberg R, Borel Rinkes IH, Vriens MR, Molenaar IQ (2013) Robot-assisted pancreatic surgery: a systematic review of the literature. HPB (Oxford) 15(1):1–10. https://doi.org/10.1111/j.1477-2574.2012.00589.x CrossRef

34.

Hwang HK, Kang CM, Chung YE, Kim KA, Choi SH, Lee WJ (2013) Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon's experiences and proposal of clinical application. Surg Endosc 27(3):774–781. https://doi.org/10.1007/s00464-012-2551-6 CrossRefPubMed

35.

Gumbs AA, Gres P, Madureira F, Gayet B (2008) Laparoscopic vs open resection of pancreatic endocrine neoplasms: single institution's experience over 14 years. Langenbeck's Arch Surg 393(3):391–395. https://doi.org/10.1007/s00423-007-0255-5 CrossRef

36.

Zhou ZQ, Kim SC, Song KB, Park KM, Lee JH, Lee YJ (2014) Laparoscopic spleen-preserving distal pancreatectomy: comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation. World J Surg 38(11):2973–2979. https://doi.org/10.1007/s00268-014-2671-3 CrossRefPubMed

37.

Hu M, Zhao G, Luo Y, Liu R (2011) Laparoscopic versus open treatment for benign pancreatic insulinomas: an analysis of 89 cases. Surg Endosc 25(12):3831–3837. https://doi.org/10.1007/s00464-011-1800-4 CrossRefPubMed

38.

Haugvik SP, Marangos IP, Rosok BI, Pomianowska E, Gladhaug IP, Mathisen O, Edwin B (2013) Long-term outcome of laparoscopic surgery for pancreatic neuroendocrine tumors. World J Surg 37(3):582–590. https://doi.org/10.1007/s00268-012-1893-5 CrossRefPubMed

39.

Qu L, Zhiming Z, Xianglong T, Yuanxing G, Yong X, Rong L, Yee LW (2018) Short-and mid-term outcomes of robotic versus laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma: a retrospective propensity score-matched study. Int J Surg 55:81–86CrossRefPubMed

40.

Guerrini GP, Lauretta A, Belluco C, Olivieri M, Forlin M, Basso S, Breda B, Bertola G, Di Benedetto F (2017) Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg 17(1):105CrossRefPubMedPubMedCentral

41.

Lo CY, Chan WF, Lo CM, Fan ST, Tam PK (2004) Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 18(2):297–302. https://doi.org/10.1007/s00464-003-8156-3 CrossRefPubMed

42.

Butturini G, Damoli I, Crepaz L, Malleo G, Marchegiani G, Daskalaki D, Esposito A, Cingarlini S, Salvia R, Bassi C (2015) A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc 29(11):3163–3170. https://doi.org/10.1007/s00464-014-4043-3 CrossRefPubMed

43.

Magge D, Gooding W, Choudry H, Steve J, Steel J, Zureikat A, Krasinskas A, Daouadi M, Lee KK, Hughes SJ, Zeh HJ 3rd, Moser AJ (2013) Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg 148(6):525–531. https://doi.org/10.1001/jamasurg.2013.1673 CrossRefPubMed

44.

Han SH, Han IW, Heo JS, Choi SH, Choi DW, Han S, You YH (2017) Laparoscopic versus open distal pancreatectomy for nonfunctioning pancreatic neuroendocrine tumors: a large single-center study. Surg Endosc 32:443–449. https://doi.org/10.1007/s00464-017-5702-y CrossRefPubMed

45.

Xourafas D, Tavakkoli A, Clancy TE, Ashley SW (2015) Distal pancreatic resection for neuroendocrine tumors: is laparoscopic really better than open? J Gastrointest Surg 19(5):831–840. https://doi.org/10.1007/s11605-015-2788-1 CrossRefPubMedPubMedCentral

46.

Phan GQ, Yeo CJ, Hruban RH, Lillemoe KD, Pitt HA, Cameron JL (1998) Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: review of 125 patients. J Gastrointest Surg 2(5):472–482CrossRefPubMed

Titel: Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study
verfasst von: Sergio Alfieri
Giovanni Butturini
Ugo Boggi
Andrea Pietrabissa
Luca Morelli
Fabio Vistoli
Isacco Damoli
Andrea Peri
Claudio Fiorillo
Luigi Pugliese
Marco Ramera
Nelide De Lio
Gregorio Di Franco
Alessandro Esposito
Luca Landoni
Fausto Rosa
Roberta Menghi
Giovanni Battista Doglietto
Giuseppe Quero
The Italian Robotic pNET Group
Publikationsdatum: 04.05.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 4/2019
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-019-01786-x

Neu im Fachgebiet Chirurgie

23.04.2024 | Ablationstherapie | Nachrichten

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich

weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2019

Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons (CAEK)

Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate

Cure and survival of sporadic medullary thyroid carcinoma following systematic preoperative calcitonin screening

Synchronous liver metastases and peritoneal carcinomatosis from colorectal cancer: different strategies for curative treatment?

Laser speckle contrast imaging and quantitative fluorescence angiography for perfusion assessment

Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Hinter dieser Appendizitis steckte ein Erreger

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Ureterstriktur: Innovative OP-Technik bewährt sich

Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“