Annals of surgery · 2025
Robot-assisted and Laparoscopic Extended Left Pancreatectomy: A Pan-European Multicenter Propensity-score Matched Analysis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Bruna Caro L, van Ramshorst Tess, van Hilst Jony, Balduzzi Alberto, Koerkamp Bas Groot, Dokmak Safi, Busch Olivier R, Berrevoet Frederik, Ramera Marco, Edwin Bjørn, Boggi Ugo, Festen Sebastiaan, Wittel Uwe A, Balsells Joaquim, Sergeant Gregory, Ferrari Giovanni, Biesel Esther A, Luyer Misha D P, van den Boezem Peter B, Lopez-Ben Santiago, Petrič Miha, Soonawalla Zahir, de Wilde Roeland, Aussilhou Beatrice, Besselink Marc G, Abu Hilal Mohammad, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
Аннотация
OBJECTIVE: To compare postoperative outcomes after extended robot-assisted left pancreatectomy (e-RLP) and extended laparoscopic left pancreatectomy (e-LLP).
SUMMARY BACKGROUND DATA: The implementation of RLP is increasing worldwide with expanding indications, resulting in more extended resections. However, the use of e-RLP has not been investigated before.
METHODS: International study including consecutive patients after e-RLP and e-LLP for all indications in 19 European countries (2012-2022). Extended resection was defined according to the ISGPS definition. Propensity score matching (PSM) was performed in a 1:1 ratio with a caliper width of 0.1. Primary endpoint was major morbidity (Clavien-Dindo grade ≥III complications).
RESULTS: Overall, 514 patients were included from 72 centers (152 e-RLPs; 362 e-LLPs). Before PSM, e-RLP patients had more tail tumors (69.4% vs 50.0%, P=0.001), vascular involvement (30.3% vs 16.3%, P<0.001) and >2 additional organ resections (28.5% vs 10.7%, P<0.001), with comparable major morbidity rates (27.0% vs 27.0%, P=0.991) and a lower conversion rate (15.1% vs 23.5%, P=0.033), compared to e-LLP. After PSM, 119 e-RLP patients were matched to 119 e-LLP patients. No significant differences were observed in major morbidity (23.5% vs 26.5%, P=0.599), blood loss (200 vs 150 mL, P=0.835), conversion rate (16.0% vs 20.0%, P=0.422), 30-day/in-hospital mortality (1.7% vs 3.4%, P=0.408), and hospital stay (median 7 vs 7 days, P=0.906). E-RLP had longer operative times (median 277 vs 228 min, P<0.001).
CONCLUSIONS: This pan-European cohort study found no significant differences in the outcomes among matched patients undergoing e-RLP and e-LLP, although e-RLP was associated with a longer operative time. The robot-assisted approach is used for more extensive resections with a comparable major morbidity rate compared to laparoscopy.
SUMMARY BACKGROUND DATA: The implementation of RLP is increasing worldwide with expanding indications, resulting in more extended resections. However, the use of e-RLP has not been investigated before.
METHODS: International study including consecutive patients after e-RLP and e-LLP for all indications in 19 European countries (2012-2022). Extended resection was defined according to the ISGPS definition. Propensity score matching (PSM) was performed in a 1:1 ratio with a caliper width of 0.1. Primary endpoint was major morbidity (Clavien-Dindo grade ≥III complications).
RESULTS: Overall, 514 patients were included from 72 centers (152 e-RLPs; 362 e-LLPs). Before PSM, e-RLP patients had more tail tumors (69.4% vs 50.0%, P=0.001), vascular involvement (30.3% vs 16.3%, P<0.001) and >2 additional organ resections (28.5% vs 10.7%, P<0.001), with comparable major morbidity rates (27.0% vs 27.0%, P=0.991) and a lower conversion rate (15.1% vs 23.5%, P=0.033), compared to e-LLP. After PSM, 119 e-RLP patients were matched to 119 e-LLP patients. No significant differences were observed in major morbidity (23.5% vs 26.5%, P=0.599), blood loss (200 vs 150 mL, P=0.835), conversion rate (16.0% vs 20.0%, P=0.422), 30-day/in-hospital mortality (1.7% vs 3.4%, P=0.408), and hospital stay (median 7 vs 7 days, P=0.906). E-RLP had longer operative times (median 277 vs 228 min, P<0.001).
CONCLUSIONS: This pan-European cohort study found no significant differences in the outcomes among matched patients undergoing e-RLP and e-LLP, although e-RLP was associated with a longer operative time. The robot-assisted approach is used for more extensive resections with a comparable major morbidity rate compared to laparoscopy.