Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: a single institutional assessment of perioperative outcomes and survival

Ocuin, Lee M.; Miller-Ocuin, Jennifer L.; Novak, Stephanie; Bartlett, David L.; Marsh, J. Wallis; Tsung, Allan; Lee, Kenneth K.; Hogg, Melissa E.; Zeh, Herbert J.; Zureikat, Amer H.

doi:10.1016/j.hpb.2016.05.003

Cited by 64 publications

(66 citation statements)

References 31 publications

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“…Although radical antegrade modular pancreatosplectomy has also been performed using pure laparoscopic techniques 12,28 , the use of a robotic system is thought to facilitate the procedure due to the enhanced dexterity offered by robotic assistance When the tumor is located close to the neck of the pancreas, involvement of the superior mesenteric-portal vein and/or the celiac trunk may occur, further complicating the procedure. Both arterial and venous resections have been performed using robotic assistance during radical antegrade modular pancreatosplectomy 30 , but the safety and oncologic efficacy of these procedures remain to be established.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

Napoli

Kauffmann

Menonna

et al. 2020

JoVE

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This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with the legs parted and a pneumoperitoneum is established and maintained at 10 mmHg. To use the surgical system, four 8 mm ports and one 12 mm port are required. The optic port is placed at the umbilicus. The other ports are placed, on either side, along the pararectal line and the anterior axillary line at the level of the umbilical line. The assistant port (12 mm) is placed along the right pararectal line. Dissection begins by detaching the gastrocolic ligament, thus opening the lesser sac, and by a wide mobilization of the splenic flexure of the colon. The superior mesenteric vein is identified along the inferior border of the pancreas. Lymph node number 8a is removed to permit clear visualization of the common hepatic artery. A tunnel is then created behind the neck of the pancreas. To permit safe resection and reconstruction of the spleno-mesenteric junction, further preemptive dissection is required before dividing the pancreatic neck to bring in clear view all relevant vascular pedicles. Next, the splenic artery is ligated and divided, and the pancreatic neck is divided, with selective ligature of the pancreatic duct. After vein resection and reconstruction, dissection proceeds to complete the clearance of peripancreatic arteries that are peeled off from all lympho-neural tissues. Both celiac ganglia are removed en-bloc with the specimen. The Gerota fascia covering the upper pole of the left kidney is also removed en-bloc with the specimen. Division of short gastric vessels and splenectomy complete the procedure. A drain is left near the pancreatic stump. The round ligament of the liver is mobilized to protect the vessels. Video Link The video component of this article can be found at https://www.jove.com/video/60370/ 12 , the complexity of this procedure and the high rate of margin negative resection reported after robotic procedures 13 suggest that robotic assistance could be rewarding in this operation. We herein describe the technique for robotic assisted RAMPS, that was developed in a center with experience in thousands of robotic procedures and in over 350 robotic pancreatic resections. Protocol The procedure described herein was conducted in compliance with the guidelines set out by the Ethics Committee of Pisa University Hospital for robotic operations, including regulations on research activity.

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Section: Discussionmentioning

confidence: 99%

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

Napoli

Kauffmann

Menonna

et al. 2020

JoVE

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“…). Patients achieved a median survival of 35 months with a 79% rate of R0 resections . Another matched analysis of 17 patients undergoing a modified Appleby at Johns Hopkins Hospital shows a median survival of 20 months .…”

Section: Surgical Treatment Of Borderline and Locally Advanced Pancrementioning

confidence: 99%

Surgical strategies and novel therapies for locally advanced pancreatic cancer

Abou-Khalil

Rocha

2017

Journal of Surgical Oncology

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Many patients with pancreatic cancer are not candidates for surgical resection due to involvement of critical mesenteric vascular structures. We compare and contrast the commonly used classification systems for borderline resectable and locally advanced pancreatic cancer. We describe the current strategies in managing venous and arterial involvement, as well as the role of neoadjuvant chemotherapy and chemoradiation, before explanding on a novel clinical trial in this patient population.

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“…Robotic distal pancreatectomy combined with celiac axis resection pancreatic surgeons, reporting oncologic outcomes that rival resectable and borderline resectable disease (11,12).…”

Section: Review Article On Pancreatic Surgerymentioning

confidence: 99%

“…At the University of Pittsburgh, we have attempted to curtail some of the morbidity of pancreatic resections by applying minimally invasive-in particular roboticplatforms to complex gastrointestinal (GI) procedures such as the DP-CAR. Recently, we summarized our 30-case experience and compared 19 open to 11 robotic DP-CARs performed between 2008-2015; morbidity was acceptable in both groups while a decrease in operative time, blood loss, blood transfusion was observed in the robotic cohort (12). Notably, no robotic cases were converted to open DP-CAR and median survival in both groups was nearly 3 years.…”

Section: Review Article On Pancreatic Surgerymentioning

confidence: 99%

Robotic distal pancreatectomy combined with celiac axis resection

Greer

Zureikat

2017

J. Vis. Surg.

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A subset of pancreatic body and tail cancers present with locally advanced disease due to involvement of the celiac axis. Previously considered unresectable, these T4 tumors may be extirpated with a distal pancreatectomy and resection of the celiac trunk in carefully selected patients. In the setting of multimodality treatment, these resections can yield survival similar to resectable and borderline resectable lesions. Robotic surgery has been shown to be safe and feasible in complex pancreatic resections. This article summarizes our patient selection criteria and operative approach to robotic distal pancreatectomy with celiac axis resection (DP-CAR) for locally advanced body and tail tumors of the pancreas.

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Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: a single institutional assessment of perioperative outcomes and survival

Abstract: Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is an option for T4 tumors of

Cited by 64 publications

References 31 publications

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

Surgical strategies and novel therapies for locally advanced pancreatic cancer

Robotic distal pancreatectomy combined with celiac axis resection

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