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Robotic versus laparoscopic distal pancreatectomy in obese patients

Lookup NU author(s): Steven White

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2023, The Author(s).Background: Although robotic distal pancreatectomy (RDP) has a lower conversion rate to open surgery and causes less blood loss than laparoscopic distal pancreatectomy (LDP), clear evidence on the impact of the surgical approach on morbidity is lacking. Prior studies have shown a higher rate of complications among obese patients undergoing pancreatectomy. The primary aim of this study is to compare short-term outcomes of RDP vs. LDP in patients with a BMI ≥ 30. Methods: In this multicenter study, all obese patients who underwent RDP or LDP for any indication between 2012 and 2022 at 18 international expert centers were included. The baseline characteristics underwent inverse probability treatment weighting to minimize allocation bias. Results: Of 446 patients, 219 (50.2%) patients underwent RDP. The median age was 60 years, the median BMI was 33 (31–36), and the preoperative diagnosis was ductal adenocarcinoma in 21% of cases. The conversion rate was 19.9%, the overall complication rate was 57.8%, and the 90-day mortality rate was 0.7% (3 patients). RDP was associated with a lower complication rate (OR 0.68, 95% CI 0.52–0.89; p = 0.005), less blood loss (150 vs. 200 ml; p < 0.001), fewer blood transfusion requirements (OR 0.28, 95% CI 0.15–0.50; p < 0.001) and a lower Comprehensive Complications Index (8.7 vs. 8.9, p < 0.001) than LPD. RPD had a lower conversion rate (OR 0.27, 95% CI 0.19–0.39; p < 0.001) and achieved better spleen preservation rate (OR 1.96, 95% CI 1.13–3.39; p = 0.016) than LPD. Conclusions: In obese patients, RDP is associated with a lower conversion rate, fewer complications and better short-term outcomes than LPD.


Publication metadata

Author(s): Ausania F, Landi F, Martinie JB, Vrochides D, Walsh M, Hossain SM, White S, Prabakaran V, Melstrom LG, Fong Y, Butturini G, Bignotto L, Valle V, Bing Y, Xiu D, Di Franco G, Sanchez-Bueno F, de'Angelis N, Laurent A, Giuliani G, Pernazza G, Esposito A, Salvia R, Bazzocchi F, Esposito L, Pietrabissa A, Pugliese L, Memeo R, Uyama I, Uchida Y, Rios J, Coratti A, Morelli L, Giulianotti PC

Publication type: Article

Publication status: Published

Journal: Surgical Endoscopy

Year: 2023

Volume: 37

Pages: 8384–8393

Print publication date: 01/11/2023

Online publication date: 15/09/2023

Acceptance date: 30/07/2023

Date deposited: 05/10/2023

ISSN (print): 0930-2794

ISSN (electronic): 1432-2218

Publisher: Springer

URL: https://doi.org/10.1007/s00464-023-10361-x

DOI: 10.1007/s00464-023-10361-x


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CRUE-CSIC

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