Open and minimally invasive pancreatic neoplasms enucleation: a systematic review

Valle, Raffaele Dalla; Cremaschi, Elena; Lamecchi, L.; Guerini, F.; Rosso, Edoardo; Iaria, Maurizio

doi:10.1007/s00464-019-06967-9

Cited by 21 publications

(7 citation statements)

References 64 publications

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“…This rate was acceptable since it was reported to be up to 60% in the literature. [7][8][9][10] Also, as showed in our study, the rate was not increased compared with that for tumors in a larger distance from MPD. Although the operative duration was significantly longer, considering the successful preservation of the pancreatic endocrine and exocrine function, it was worthy for the patients to suffer from the prolonged time of operation and prolonged time of drainage.…”

Section: Discussionsupporting

confidence: 50%

“…PE was proved to be efficient and safe in previous studies, 1,2 with a significantly improved prognosis. 3 However, high risk of post-operative pancreatic fistula (POPF) [4][5][6][7][8][9] remained to be the major drawback of PE, compared with distal pancreatectomy and pancreatoduodenectomy, especially for tumors close to the major pancreatic duct (MPD). 10 Thus, a minimal distance of 3 mm to MPD was generally considered to be necessary for PE.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Ultrasound Guided Robotic Pancreatic Enucleation, Does a Distance of 3mm Still Matters?

et al. 2022

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Background: A minimal distance of 3 mm to main pancreatic duct (MPD) was generally considered to be necessary for pancreatic enucleation (PE). This study was designed to report the safety and feasibility of PE for tumors located in 3 mm to MPD Under the intraoperative ultrasound (IOUS) guidance. Methods: The data of patients who received IOUS guided robotic PE from January 2018 to May 2019 in the second department of hepato-pancreato-biliary surgery were reviewed in this study. According to the distance to MPD (less than 3 mm or not), patients were divided in 2 groups, and the short-term operative outcomes were compared. Statistics: Students’ t-test and Mann-Whitney U test were used for comparing continuous variables, and Chi-squared test was used for comparing categorical variables. Results: And a total of 56 patients were analyzed, and a minimal distance less than 3 mm between the tumor and pancreatic duct measured by IOUS was found in 12 patients. The tumors and MPD were clearly revealed intraoperatively in all the cases. The operative duration was significantly longer in patients with tumors located in 3 mm from MPD (143.25 ± 40.89 min vs 107.14 ± 37.73 min, t = 2.756, P=.014). There was no significant difference between the rate of post-operative pancreatic fistula and other complications in the different groups (χ2 =.924, P=.48). Discussion and conclusion: robotic PE could be safely performed under IOUS guidance for benign or low-grade malignant tumors located less than 3 mm to the MPD.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Intraoperative Ultrasound Guided Robotic Pancreatic Enucleation, Does a Distance of 3mm Still Matters?

et al. 2022

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“…Robotic pancreatic enucleation shows less conversion to open surgery compared to laparoscopic pancreatic enucleation with comparable short-term outcomes ( 100 ). Besides, robotic pancreatic enucleation is associated with less trauma, faster wound recovery, less intraoperative blood loss, shorter LOH, shorter operative time, less overall complications with no differences in long-term outcomes ( 101 - 104 ). RCTs are lacking.…”

Section: Resultsmentioning

confidence: 99%

International consensus guidelines on robotic pancreatic surgery in 2023

Liu,

Abu Hilal,

Besselink

et al. 2024

Hepatobiliary Surg Nutr

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Background With the rapid development of robotic surgery, especially for the abdominal surgery, robotic pancreatic surgery (RPS) has been applied increasingly around the world. However, evidence-based guidelines regarding its application, safety, and efficacy are still lacking. To harvest robust evidence and comprehensive clinical practice, this study aims to develop international guidelines on the use of RPS. Methods World Health Organization (WHO) Handbook for Guideline Development, GRADE Grid method, Delphi vote, and the AGREE-II instrument were used to establish the Guideline Steering Group, Guideline Development Group, and Guideline Secretary Group, formulate 19 clinical questions, develop the recommendations, and draft the guidelines. Three online meetings were held on 04/12/2020, 30/11/2021, and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts. All the experts focusing on minimally invasive surgery from America, Europe and Oceania made great contributions to this consensus guideline. Results After a systematic literature review 176 studies were included, 19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence. Conclusions The international RPS guidelines can guide current practice for surgeons, patients, medical societies, hospital administrators, and related social communities. Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.

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“…A systematic review of 343 patients who underwent MIEn revealed that the overall PF and Grade B/C PF rates after MIEn were 28.7% and 20.5%, respectively. [ 25 ] The POPF rate after MIEn varied greatly between studies. To avoid POPF, some approaches, such as fibrin glue using a harmonic scalpel or stapler to dissect neoplasms and somatostatin analogues, have been used in the PE.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive enucleation versus open enucleation for benign or low-grade malignant pancreatic neoplasms: Effects on clinical outcomes and quality of life

Huang

Wang

et al. 2023

Journal of Minimal Access Surgery

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Introduction: The efficacy and safety of minimally invasive pancreatic enucleation (PE) have rarely been investigated. This study aimed to compare the perioperative and long-term outcomes of minimally invasive enucleation (MIEn) with those of open enucleation (OEn) for benign/low-grade malignant pancreatic neoplasms. Patients and Methods: Data collected from patients who underwent PE between January 2011 and June 2020 at our centre were analysed. Results: Forty-two patients who underwent MIEn (10 – robot-assisted and 32 – laparoscopic) and 47 who underwent OEn were included in this study. Compared with the OEn group, the MIEn group showed shorter operation time (147.6 ± 71.3 min vs. 183.1 ± 64.3 min), shorter post-operative hospital stay (11.5 ± 3.9 days vs. 13.4 ± 4.2 days), shorter off-bed activity time (2.9 ± 0.9 days vs. 3.7 ± 1.0 days) and lower estimated blood loss (EBL) (118.5 ± 59.2 mL vs. 153.1 ± 85.0 mL). Overall complication rate (47.6% vs. 55.3%), overall post-operative pancreatic fistula (POPF) rate (40.5% vs. 44.7%) and Grade B + C POPF rate (11.9% vs. 19.1%) were similar in both the groups. For neoplasms located in the proximal pancreas, MIEn showed more favourable perioperative outcomes than OEn. Unlike MIEn for superficial neoplasms, MIEn for neoplasms deeply embedded in the pancreas resulted in a longer operative time and tended to increase EBL and the incidence of complications and POPF. During the follow-up period, no significant differences were observed between these two groups in terms of pancreatic function or quality of life. Conclusions: Compared to OEn, MIEn is effective and safe for patients with benign or low-grade malignant pancreatic neoplasms. However, MIEn for embedded pancreatic neoplasms is recommended only in experienced centres because of the high rates of complications and POPF.

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Open and minimally invasive pancreatic neoplasms enucleation: a systematic review

Cited by 21 publications

References 64 publications

Intraoperative Ultrasound Guided Robotic Pancreatic Enucleation, Does a Distance of 3mm Still Matters?

Intraoperative Ultrasound Guided Robotic Pancreatic Enucleation, Does a Distance of 3mm Still Matters?

International consensus guidelines on robotic pancreatic surgery in 2023

Minimally invasive enucleation versus open enucleation for benign or low-grade malignant pancreatic neoplasms: Effects on clinical outcomes and quality of life

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