Comparison between robot‐assisted middle pancreatectomy and robot‐assisted distal pancreatectomy for benign or low‐grade malignant tumours located in the neck of the pancreas: A propensity score matched study

Abstract

Objective To compare the short‐term and long‐term outcomes between robot‐assisted middle pancreatectomy (RMP) and robot‐assisted distal pancreatectomy (RDP). Methods From August 2010 to May 2018, more than 800 patients were diagnosed with benign or low‐grade malignant pancreatic tumours. According to the inclusion criteria, a total of 164 patients were included in our study. Among them 123 patients received RMP and 41 patients received RDP with spleen‐preserving. These patients were divided into two groups, and propensity score matching (PSM) was used to minimize bias. Short‐term and long‐term outcomes were recorded and analysed. Results After 1:1 matching, 38 cases of RMP and RDP were recorded and the baseline data was balanced. In the RMP group, 14 patients (36.8%) were female. In the RDP group, 13 patients (34.2%) were female. RDP had advantages in short‐term outcomes including overall morbidity (28.9% vs. 60.5%, p = 0.011), Severe morbidity (0 vs. 10.5%, p = 0.017), clinical‐relevant postoperative pancreatic fistula (CR‐POPF) rate (10.5% vs. 36.8%, p = 0.007) and postoperative length of hospital stay (16.5 ± 8.6 days vs. 23.6 ± 12.9 days, p = 0.006). The operative time was similar; however, there were less estimated blood loss (EBL) in RMP group (31.3 ± 33.0 ml vs. 62.3 ± 38.2 ml, p<0.001). Patients in these two groups had a similar result in preservation of the pancreatic function. There was no statistic difference in incidence rate of exocrine and endocrine insufficiency between two groups (2.6% vs. 7.9%, p = 0.608; 5.3% vs. 10.5%, p = 0.671). Conclusion For benign or low‐grade malignant tumours located at the neck of the pancreas, RMP and RDP could both be considered. The morbidity especially CR‐POPF rate after RDP would be lower, but RMP would be more helpful in reducing EBL. RMP should be chosen with caution as it did not show a huge advantage in preserving normal pancreatic function. Further prospective randomised studies should be designed to compare these two types of surgery.

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

“…This complication was conservatively treated. In line with this trend, many studies have compared minimally invasive CP and minimally invasive DP; furthermore, studies comparing CP and SPDP, which is less invasive than conventional DP, have also been published to date 30,34–37 . Particularly, most articles that have compared postoperative endocrine function between CP and DP in only patients with MIS found no significant difference in postoperative endocrine function between the two procedures 36,37 .…”

“…In line with this trend, many studies have compared minimally invasive CP and minimally invasive DP; furthermore, studies comparing CP and SPDP, which is less invasive than conventional DP, have also been published to date. 30,[34][35][36][37] Particularly, most articles that have compared postoperative endocrine function between CP and DP in only patients with MIS found no significant difference in postoperative endocrine function between the two procedures. 36,37 In 2019, Zhang et al 38 compared the proportion of postoperative insulin treatment between laparoscopic CP (n = 23) and laparoscopic SPDP (n = 36) groups and found no significant difference between the groups (0% vs.…”

“…30,[34][35][36][37] Particularly, most articles that have compared postoperative endocrine function between CP and DP in only patients with MIS found no significant difference in postoperative endocrine function between the two procedures. 36,37 In 2019, Zhang et al 38 compared the proportion of postoperative insulin treatment between laparoscopic CP (n = 23) and laparoscopic SPDP (n = 36) groups and found no significant difference between the groups (0% vs.…”

“…3%, p = 1.000). Shi et al 36 compared the incidence of endocrine insufficiency between robot-assisted CP and robot-assisted DP groups and reported that the incidence rate of endocrine insufficiency was similar between the groups (5.3% vs. 10.5%, p = 0.671). To our knowledge, no studies have focused on how MIS affects endocrine function after pancreatectomy, which is an important topic of focus in the future.…”

“…In 2019, Zhang et al 38 compared the proportion of postoperative insulin treatment between laparoscopic CP ( n = 23) and laparoscopic SPDP ( n = 36) groups and found no significant difference between the groups (0% vs. 3%, p = 1.000). Shi et al 36 compared the incidence of endocrine insufficiency between robot‐assisted CP and robot‐assisted DP groups and reported that the incidence rate of endocrine insufficiency was similar between the groups (5.3% vs. 10.5%, p = 0.671). To our knowledge, no studies have focused on how MIS affects endocrine function after pancreatectomy, which is an important topic of focus in the future.…”