A Propensity Score–Matched Analysis of Robotic vs Open Pancreatoduodenectomy on Incidence of Pancreatic Fistula

McMillan, Matthew T.; Zureikat, Amer H.; Hogg, Melissa E.; Kowalsky, Stacy J.; Zeh, Herbert J.; Sprys, Michael H.; Vollmer, Charles M.

doi:10.1001/jamasurg.2016.4755

Cited by 132 publications

(89 citation statements)

References 44 publications

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“…Zureikat et al reported RPD was associated with a clinically significant (grade B‐C) POPF rate of 13.74% and a major complication (Clavien ≥3) rate of 23.7%. McMillan and associates also reported a clinically significant (grade B‐C) pancreatic fistula rate of 6.6% and a major morbidity (Clavien ≥3) rate of 23.0% after RPD. Polanco and colleagues analyzed 150 consecutive RPDs and demonstrated that grade B POPF occurred in 17.3% of patients and grade C POPF in 8.6% of patients.…”

Section: Discussionmentioning

confidence: 92%

“…Robotic surgery has recently been developed to improve visualization and dexterous manipulation over conventional laparoscopy , which can make the pancreatic and biliary reconstructions more convenient . The robotic approach is safe and feasible for PD and is noninferior to the open approach for perioperative outcomes . However, RPD is one of the most technically challenging procedures for robotic abdominal surgery, and RPDs are currently performed in few selected patients in several high‐volume robotic centers .…”

Section: Discussionmentioning

confidence: 99%

“…Recent developments in robotic surgery have overcome many limitations of laparoscopic surgery and allowed robotic techniques to be gradually adopted in the field of pancreatic surgery . Since robotic PD (RPD) was first described in 2003 , many reports demonstrated that RPD was technically safe and feasible in selected patients . Because of the complexity of digestive tract reconstruction and superior robotic surgical skills required, RPD has not been widely performed but rather limited to a few highly specialized centers .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Novel single‐layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Liu

Zhao

Gao

et al. 2019

J Hepato Biliary Pancreat

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Background The best technique for pancreatic anastomosis after pancreaticoduodenectomy (PD) remains controversial, and the procedure for robotic PD (RPD) has not been previously reported. This study aimed to evaluate the safety and feasibility of a novel technique of pancreaticojejunostomy (PJ) for RPD. Methods The demographics and perioperative outcomes of a consecutive series of RPD patients who underwent single‐layer continuous suture (SCS) for PJ between September 2018 and November 2018 were analyzed. Results Thirty patients were included in the study. Twenty patients had a soft pancreas, and 15 patients had a small main pancreatic duct (MPD) (<3 mm). The mean operative time was 234.1 min, the mean duration of PJ was 14.9 min, and the median estimated blood loss was 100.0 ml. No patients required conversion to laparotomy. Postoperative pancreatic fistula (POPF) included seven cases of Grade A and two cases of Grade B. No case of Grade C POPF occurred. The mean postoperative hospital stay was 12.3 days. No 90‐day readmission or mortality was observed. Neither pancreatic texture nor MPD size affected the perioperative outcomes. Conclusions Single‐layer continuous suture is easy to perform and is associated with favorable clinical outcomes, regardless of the pancreatic duct size and texture.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Novel single‐layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Liu

Zhao

Gao

et al. 2019

J Hepato Biliary Pancreat

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“…POPF is the most serious complication with high incidence of hemorrhage, abdominal infection, and delayed gastric emptying (DGE). It also links to a series of social problems, such as increased costs of hospitalization and longer hospital stay . Prevention of POPF including pancreatic duct drainage, somatostatin analogs, or biological sealants has been identified as useful strategies for decreasing the incidence of POPF .…”

Section: Introductionmentioning

confidence: 99%

“…It also links to a series of social problems, such as increased costs of hospitalization and longer hospital stay. [3][4][5][6] Prevention of POPF including pancreatic duct drainage, somatostatin analogs, or biological sealants has been identified as useful strategies for decreasing the incidence of POPF. [5][6][7][8][9] Therefore, it would be crucial to screen patients with a high risk for POPF and to take optimize preoperative and intraoperative strategies for decreasing the hazard of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

HYAL‐1‐induced autophagy facilitates pancreatic fistula for patients who underwent pancreaticoduodenectomy

Fengyu

Yuan

et al. 2019

FASEB j.

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The main mechanism of hyaluronidase 1(HYAL-1) in the development of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) was unknown. In this study, a comprehensive inventory of pre-, intra-, and postoperative clinical and biological data of two cohorts (62 pancreatic cancer [PCa] and 111 pancreatic ductal adenocarcinoma [PDAC]) which could induce POPF were retrospectively analyzed.Then, a total of 7644 genes correlated with HYAL-1 was predicted in PDAC tissues and the enriched pathway, kinase targets and biological process of those correlated genes were evaluated. Finally, a mouse pancreatic fistula (PF) model was first built and in vitro studies were performed to investigate the effects of HYAL-1 on PF progression. Our data indicated that preoperative serum HYAL-1 level, pancreatic fibrosis score, and pancreatic duct size were valuable factors for detecting POPF of Grade B and C. The serum HYAL-1 level of 2.07 mg/ml and pancreatic fibrosis score of 2.5 were proposed as the cutoff values for indicating POPF. The bioinformatic analysis and in vitro and in vivo studies demonstrated that HYAL-1 facilitates pancreatic acinar cell autophagy via the dephosphorylation of adenosine 5'-monophosphate-activated protein kinase (AMPK) and signal transducers and activators of transcription 3 (STAT3) signaling pathways, which exacerbate pancreatic secretion and inflammation. In summary, the preoperative serum HYAL-1 was a significant predictor for POPF in patients who underwent PD. Tumor-induced HYAL-1 is one of core risk in accelerating PF and then promoting pancreatic secretion and acute inflammation response through the AMPK and STAT3-induced autophagy. K E Y W O R D Sautophagy, fibrosis, HYAL-1, pancreaticoduodenectomy, pancreatic fistula | 2525 LI et aL.

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Comparing Outcomes for Robotic and Open Pancreatoduodenectomy

Kooby

Kim

2017

JAMA Surg

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A Propensity Score–Matched Analysis of Robotic vs Open Pancreatoduodenectomy on Incidence of Pancreatic Fistula

Abstract: To our knowledge, this is the first propensity score-matched analysis of robotic vs open pancreatoduodenectomy to date, and it demonstrates that RPD is noninferior to OPD in terms of pancreatic fistula development and other major postoperative outcomes.

Cited by 132 publications

References 44 publications

Novel single‐layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Novel single‐layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

HYAL‐1‐induced autophagy facilitates pancreatic fistula for patients who underwent pancreaticoduodenectomy

Comparing Outcomes for Robotic and Open Pancreatoduodenectomy

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