Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?

Abstract

BackgroundThe most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive surgery has been increasingly used in pancreatectomy. Initial results in robotic distal pancreatectomy (RDP) have been encouraging. Nonetheless, data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare. The aim of this study was to compare the safety and efficacy of RDP and LDP for PNETs.MethodsFrom September 2010 to January 2017, operative parameters and perioperative outcomes in an initial experience with 43 consecutive patients undergoing RDP were collected and compared with those in 31 patients undergoing LDP.ResultsPatients undergoing RDP and LDP demonstrated equivalent age, sex, ASA score, tumor location and tumor size. Operating time, length of resected pancreas, postoperative length of hospital stay and rates of conversion to open, pancreatic fistula, transfusion and reoperation were not statistically different. Patients in the RDP group were associated with significantly higher overall (79.1 vs. 48.4 %, P = 0.006) and Kimura spleen preservation rates (72.1 vs. 16.1%, P < 0.001) and had reduced risk of excessive blood loss (50 vs. 200mL, P < 0.001). Oncological outcomes in this series were superior for the RDP group with more lymph node harvest for G2 and G3 PNETs (3.5 vs. 2, P = 0.034).ConclusionsBoth RDP and LDP are efficacious and safe methods in treating PNETs located in the body or tail of pancreas. Robotic approach offers advantages with less intraoperative blood loss, higher spleen preservation rate and more lymph node harvest. It may be sensible to choose RDP for patients who fit indications for scheduled spleen preservation.

Robotic enucleation for pediatric insulinoma with MEN1 syndrome: a case report and literature review

“…The Da Vinci Surgical System enables robot-assisted surgery, which provides surgeons with a three-dimensional view, high articulation ability, scaling functions, filtering functions to avoid shaking, and visual magnification. When it comes to pancreatic surgery, several studies have reported the advantages of robotic approach over conventional laparoscopic means, such as less rate of conversion to laparotomy, less blood loss and shorter postoperative hospital stay [ 29 , 30 ]. However, enucleation of pNETs via robotic surgery has been described only a few times worldwide.…”

Surgical resection of pancreatic neuroendocrine neoplasm by minimally invasive surgery—the robotic approach?

“…Nevertheless, regardless of the role of lymphadenectomy in prognosis, adequate lymph nodes retrieval should still be achieved for accurate staging. Zhang et al (52) found that there was no difference in terms of resection margins in their group of patients with PNENs, as both groups achieved negative margins in all patients. The study did not evaluate for lymph nodes harvest rates.…”

“…This improves the rate of spleen and splenic vessel preservation in DP, which is beneficial to patients as it avoids complications such as splenic infarction and post-splenectomy infection. Zhang et al (52) compared outcomes in 74 patients with PNENs who underwent minimally invasive DP (n=43 in RDP group; n=31 in LDP group). There was a significantly higher rate of splenic conservation in patients who underwent RDP compared to the LDP group (78.1% vs. 48.45%; P=0.006), and the Kimura technique was more frequently utilized in the RDP group (72.1% vs. 16.1%; P<0.001).…”

Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation

“…The role of splenectomy is another debated issue, although most of the authors agree that it should be avoided if splenic vessels are not involved in the neoplastic tissue [ 93 ].…”

“…Zhang and colleagues [ 93 ] presented their initial experience comparing 43 and 31 patients undergoing robotic or laparoscopic DP for PanNETs. They found a significantly higher rate of spleen preservation (79.1 versus 48.4%, p = 0.006), lower risk of excessive blood loss, and greater number of lymph node harvested in the robotic group.…”