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Shi H, Chen Z, Dong S, He R, Du Y, Qin Z, Zhou W. A nomogram for predicting survival in patients with advanced (stage III/IV) pancreatic body tail cancer: a SEER-based study. BMC Gastroenterol 2022; 22:279. [PMID: 35658912 PMCID: PMC9164315 DOI: 10.1186/s12876-022-02362-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Pancreatic body tail carcinoma (PBTC) is a relatively few pancreatic cancer in clinical practice, and its specific clinicopathological features and prognosis have not been fully described. In this study, we aimed to create a nomogram to predict the overall survival (OS) of patients with advanced PBTC. METHODS We extracted clinical and related prognostic data of advanced PBTC patients from 2000 to 2018 from the Surveillance, Epidemiology, and End Results database. Independent prognostic factors were selected using univariate and multivariate Cox analyses, and a nomogram was constructed using R software. The C-index, area under the curve (AUC) of receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA) were used to assess the clinical utility of the nomogram. Finally, OS was assessed using the Kaplan-Meier method. RESULTS A total of 1256 patients with advanced PBTC were eventually included in this study. Age, grade, N stage, M stage, surgery, and chemotherapy were identified as independent risk factors using univariate and multivariate Cox regression analyses (p < 0.05). In the training cohort, the calibration index of the nomogram was 0.709, while the AUC values of the nomogram, age, grade, N stage, M stage, surgery, and chemotherapy were 0.777, 0.562, 0.621, 0.5, 0.576, 0.632, and 0.323, respectively. Meanwhile, in the validation cohort, the AUC values of the nomogram, age, grade, N stage, M stage, surgery, and chemotherapy were 0.772, 0.551, 0.629, 0.534, 0.577, 0.606, and 0.639, respectively. Good agreement of the model in the training and validation cohorts was demonstrated in the calibration and DCA curves. Univariate survival analysis showed a statistically significant effect of age, grade, M stage, and surgery on prognosis (p < 0.05). CONCLUSION Age, grade, M stage, and surgery were independently associated with OS, and the established nomogram was a visual tool to effectively predict OS in advanced PBTC patients.
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Affiliation(s)
- Huaqing Shi
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Zhou Chen
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Shi Dong
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Ru He
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Yan Du
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Zishun Qin
- School of Stomatology, Lanzhou University, Lanzhou, China
| | - Wence Zhou
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, 730000, China.
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Benzing C, Timmermann L, Winklmann T, Haiden LM, Hillebrandt KH, Winter A, Maurer MM, Felsenstein M, Krenzien F, Schmelzle M, Pratschke J, Malinka T. Robotic versus open pancreatic surgery: a propensity score-matched cost-effectiveness analysis. Langenbecks Arch Surg 2022; 407:1923-1933. [PMID: 35312854 PMCID: PMC9399018 DOI: 10.1007/s00423-022-02471-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/14/2022] [Indexed: 12/21/2022]
Abstract
Background Robotic pancreatic surgery (RPS) is associated with high intraoperative costs compared to open pancreatic surgery (OPS). However, it remains unclear whether several advantages of RPS such as reduced surgical trauma and a shorter postoperative recovery time could lead to a reduction in total costs outweighing the intraoperative costs. The study aimed to compare patients undergoing OPS and RPS with regards to cost-effectiveness in a propensity score-matched (PSM) analysis. Methods Patients undergoing OPS and RPS between 2017 and 2019 were included in this monocentric, retrospective analysis. The controlling department provided financial data (costs and revenues, net loss/profit). A propensity score-matched analysis was performed or OPS and RPS (matching criteria: age, American society of anesthesiologists (ASA) score, gender, body mass index (BMI), and type of pancreatic resection) with a caliper 0.2. Results In total, 272 eligible OPS cases were identified, of which 252 met all inclusion criteria and were thus included in the further analysis. The RPS group contained 92 patients. The matched cohorts contained 41 patients in each group. Length of hospital stay (LOS) was significantly shorter in the RPS group (12 vs. 19 days, p = 0.003). Major postoperative morbidity (Dindo/Clavien ≥ 3a) and 90-day mortality did not differ significantly between OPS and RPS (p > 0.05). Intraoperative costs were significantly higher in the RPS group than in the OPS group (7334€ vs. 5115€, p < 0.001). This was, however, balanced by other financial categories. The overall cost-effectiveness tended to be better when comparing RPS to OPS (net profit—RPS: 57€ vs. OPS: − 2894€, p = 0.328). Binary logistic regression analysis revealed major postoperative complications, longer hospital stay, and ASA scores < 3 were linked to the risk of net loss (i.e., costs > revenue). Conclusions Surgical outcomes of RPS were similar to those of OPS. Higher intraoperative costs of RPS are outweighed by advantages in other categories of cost-effectiveness such as decreased lengths of hospital stay.
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Affiliation(s)
- Christian Benzing
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Lea Timmermann
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Winklmann
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lena Marie Haiden
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Karl Herbert Hillebrandt
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Axel Winter
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Max Magnus Maurer
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthäus Felsenstein
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Malinka
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy: A Meta-Analysis. World J Surg 2021; 46:235-245. [PMID: 34609574 DOI: 10.1007/s00268-021-06328-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radical antegrade modular pancreatosplenectomy (RAMPS) was introduced to improve the tangential resection margin rates and N1 node clearance following resection of malignancies of the pancreatic body and tail. Owing to its technical complexity, minimally invasive RAMPS (MI-RAMPS) has only been reported by a few centers worldwide. We performed this meta-analysis to compare both short- and long-term outcomes between open RAMPS (O-RAMPS) and minimally invasive RAMPS (MI-RAMPS). METHODS A systematic search of the electronic databases PubMed, Medline (via PubMed), Cochrane Register of Controlled Trials (CENTRAL), EMBASE, Scopus and Web of Science was performed to identify eligible studies published in the English language regardless of study design. The outcomes of interest were operation time, estimated blood loss, transfusion rates, overall complications, Grade B/C post-operative pancreatic fistula (POPF) rates, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), length of stay (LOS), R0 resection rates, lymph node (LN) yield and overall survival (OS). RESULTS Five non-randomized studies comprising of a total 229 patients (89 MI-RAMPS, 140 O-RAMPS) were included for analysis. Intra-operative blood loss was observed to be significantly reduced in MI-RAMPS as compared to O-RAMPS (MD -256.16, P < 0.001), while LN yield was higher in O-RAMPS as compared to MI-RAMPS (MD -2.73, P = 0.02). There were no statistically significant differences observed for the other perioperative, oncologic and survival outcomes. CONCLUSIONS This meta-analysis provides early evidence to suggest that MI-RAMPS may produce comparable short- and long-term outcomes to O-RAMPS, when undertaken by appropriately skilled surgeons in well-selected patients. Further large-scale prospective studies are required to corroborate these findings.
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Watson MD, Baimas-George MR, Thompson KJ, Iannitti DA, Ocuin LM, Baker EH, Martinie JB, Vrochides D. Improved oncologic outcomes for minimally invasive left pancreatectomy: Propensity-score matched analysis of the National Cancer Database. J Surg Oncol 2020; 122:1383-1392. [PMID: 32772366 DOI: 10.1002/jso.26147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/17/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Minimally invasive (MIS) left pancreatectomy (LP) is increasingly used to treat pancreatic adenocarcinoma (PDAC). Despite improved short-term outcomes, no studies have demonstrated long-term benefits over open resection. METHODS The National Cancer Database was queried between 2010 and 2016 for patients with PDAC, grouped by surgical approach (MIS vs open). Demographics, comorbidities, clinical staging, and pathologic staging were used for propensity-score matching. Perioperative, short-term oncologic, and survival outcomes were compared. RESULTS After matching, both cohorts included 805 patients. There were no differences in baseline characteristics, staging, or preoperative therapy between cohorts. The MIS cohort had a shorter length of stay (6.8 ± 5.5 vs 8.5 ± 7.3 days; P < .0001) with the trend toward improved time to chemotherapy (53.9 ± 26.1 vs 57.9 ± 29.9 days; P = .0511) and margin-positive resection rate (15.3% vs 18.9%; P = .0605). Lymph node retrieval and receipt of chemotherapy were similar. The MIS cohort had higher median overall survival (28.0 vs 22.1 months; P = .0067). Subgroup analysis demonstrated the highest survival for robotic compared with laparoscopic and open LP (41.9 vs 26.6 vs 22.1 months; P < .0001). CONCLUSIONS This study demonstrates the safety of MIS LP and favorable long-term oncologic outcomes. The improved survival after MIS LP warrants further study with prospective, randomized trials.
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Affiliation(s)
- Michael D Watson
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Maria R Baimas-George
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kyle J Thompson
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - David A Iannitti
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Lee M Ocuin
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Erin H Baker
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John B Martinie
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Dionisios Vrochides
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
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5
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Minimally invasive pancreatic surgery: An upward spiral. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Zhang H, Xu Q, Tan C, Wang X, Peng B, Liu X, Li K. Laparoscopic spleen-preserving distal versus central pancreatectomy for tumors in the pancreatic neck and proximal body. Medicine (Baltimore) 2019; 98:e16946. [PMID: 31441889 PMCID: PMC6716747 DOI: 10.1097/md.0000000000016946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
For benign and borderline tumors in the pancreatic neck and proximal body, laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic central pancreatectomy (LCP) are alternative surgical procedures. Choosing between LSPDP and LCP is difficult. This retrospective cohort study was looking forward to provide evidence for clinical decision.A total of 59 patients undergoing LSPDP (Kimura procedure) and LCP between June 2013 and March 2017 were selected. The clinical outcomes of patients were compared by χ test or Fisher exact test and Student t test.This study included 36 patients in LSPDP group, and 23 patients in LCP group. The overall complications incidence in LCP group was significantly higher than LSPDP group (35 vs 6%, P = .004), and the postoperative pancreatic fistula (POPF) (grade B and C) rate and abdominal infection rate in LCP group were still significantly higher than LSPDP group (POPF 22 vs 3%, P = .019; abdominal infection 35 vs 3%, P = .001, respectively). The length of resected pancreas was significantly longer in LSPDP group (9.8 ± 2.0 vs 5.3 ± 1.1 cm, P = .007). The median follow-up was 39 months (range 12-57 months). No patient was confronted by tumor recurrence. The proportion of postoperative pancreatin and insulin treatment in LCP group were similar to LSPDP group (9 vs 17%, P = .383; 0 vs 3%, P = 1.000, respectively).For patients with poor general condition, the safety of LCP needs to be taken seriously; in some ways, LSPDP may be more secure, physiological, and easier operation for tumor located in pancreatic neck and proximal body.
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Affiliation(s)
| | - Qiaoyu Xu
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
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Jin JB, Qin K, Yang Y, Shi YS, Wu ZC, Deng XX, Chen H, Cheng DF, Shen BY, Peng CH. Robotic pancreatectomy for solid pseudopapillary tumors in the pancreatic head: A propensity score-matched comparison and analysis from a single center. Asian J Surg 2019; 43:354-361. [PMID: 31327550 DOI: 10.1016/j.asjsur.2019.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Robotic surgery is the most advanced minimally invasive technique for the treatment of complicated solid pseudopapillary tumors (SPT). The aim of this study is to evaluate feasibility of robotic surgery for the treatment of SPTs in the pancreatic head. METHODS A retrospective analysis of the clinical data of 83 SPTs in pancreatic head was conducted. Clinical characteristics were extracted and propensity score matching (PSM) was used to compare and evaluate mid-term outcomes of the two techniques. RESULTS Pancreaticoduodenectomy (PD), duodenum-preserving partial pancreatic head resection (DPPHR-P) and tumor enucleation (En) were performed in 51, 24, and 8 patients, respectively. The robotic approach was associated with a significantly lower volume of blood loss, lower need for transfusion, and faster time to post-surgery recovery. Major complications and costs were comparable for both techniques. CONCLUSION A robotic approach provides an alternative to open surgery for SPTs in the pancreatic head without increasing the incidence of clinically relevant pancreatic fistula (CRPF) or other major complications and with good patient outcomes.
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Affiliation(s)
- Jia-Bin Jin
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Kai Qin
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Yi Yang
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Yu-Sheng Shi
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Zhi-Chong Wu
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Xia-Xing Deng
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Hao Chen
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Dong-Feng Cheng
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China.
| | - Bai-Yong Shen
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China.
| | - Cheng-Hong Peng
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China.
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Zhan W, Hu M, Han C, Tian H, Jing W, Li X, Shi H, Yang X, Guo T, Su H, Ma Y. Safety and effectiveness of the da Vinci robot with the "3+2" mode for distal pancreatectomy. Cancer Med 2019; 8:4226-4234. [PMID: 31210421 PMCID: PMC6675730 DOI: 10.1002/cam4.2353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/19/2019] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Recently, no relevant research has focused on the relationship between the clinical efficacy of da Vinci robotic distal pancreatectomy (RDP) and the number of mechanical arms and assistants used for RDP. The aim of this study was to evaluate the safety, efficacy, and advantages of RDP with the "3 + 2" mode. METHODS Clinical data from 53 patients (observation group) who received RDP using the "3 + 2" mode in our department, from March 2016 to September 2018, were reviewed. An additional 53 patients who received RDP using the classical mode were chosen at random for the control group. Short-term outcomes for the two groups were compared. RESULTS There were no statistically significant differences between the two groups for estimated blood loss, postoperative day of flatus passage, postoperative hospital stay, and postoperative complication (P > 0.05). Compared with the control group, the observation group had a significantly shorter operative time (166.9 ± 13.3 vs 192.6 ± 11.1 minutes, P < 0.001), lower surgical costs ($2827.79 ± $173.02 vs $3900.63 ± $317.29, P < 0.001). CONCLUSIONS The RDP using the "3 + 2" mode can increase the exposure of surgical field, improve cooperation between assistants, lower the surgical costs, and shorten the operative time and learning curve. Moreover, the clinical effect is equal to that of RDP using the classical mode. These findings indicate that RDP using the "3 + 2" mode is safe and feasible for institutions that are equipped for robot-assisted surgery.
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Affiliation(s)
- Weipeng Zhan
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China
| | - Ming Hu
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China
| | - Caiwen Han
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
| | - Hongwei Tian
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China
| | - Wutang Jing
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China
| | - Xiaofei Li
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Hao Shi
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Xiaojun Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China
| | - Tiankang Guo
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
| | - He Su
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China
| | - Yuntao Ma
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China.,Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors in Gansu Province, Lanzhou, China
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Abstract
In pancreatic cancer, resection combined with neoadjuvant and/or adjuvant therapy remains the only chance for cure and/or prolonged survival. A minimally invasive approach to pancreatic cancer has gained increased acceptance and popularity. The aim of minimally invasive surgery of the pancreas includes limiting trauma, decreasing length of hospitalization, lessening cost, decreasing blood loss, and allowing for a more meticulous oncologic dissection. New advances and routine use in practice have helped progress the field making the minimally invasive approach more feasible. In this article, the minimally invasive surgical approaches to proximal, central, and distal pancreatic cancer are described and literature reviewed.
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Fingerhut A, Uranues S, Khatkov I, Boni L. Laparoscopic distal pancreatectomy: better than open? Transl Gastroenterol Hepatol 2018; 3:49. [PMID: 30225383 PMCID: PMC6131158 DOI: 10.21037/tgh.2018.07.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
Distal pancreatectomy is well suited to the laparoscopic approach. Laparoscopic distal pancreatectomy (LDP) provides the same postoperative recovery advantages reputed to minimal access surgery. However, there have been fears as to the safety of LDP in terms of life-threatening intra-operative events and post-operative complications, adequate carcinological outcomes as compared to traditional (open) distal pancreatectomy (ODP) when performed for cancer, as well as to whether the laparoscopic approach is well adapted to the variety of diseases that may affect the pancreas (ranging from trauma to benign or malignant disease) and whether the minimal access approach is well adapted to perform pancreatic surgery safely in the obese, the elderly or the frail. In this review of the literature, we sought to determine whether LDP was as safe, provided the same oncological outcomes and was applicable to all diseases involving the body and tail of the pancreas, and to particular patient characteristics, compared to the traditional open approach. Last we looked at cost issues. We concluded that this review of the literature allowed to state that laparoscopic distal pancreatectomy is feasible and safe for a wide range of diseases, both benign and malignant. Morbidity, mortality, and probably, also, carcinological outcomes are comparable to open surgery. The overall costs are similar but the advantages of minimal access surgery make it the preferred approach, once the surgical expertise is acquired and present.
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Affiliation(s)
- Abe Fingerhut
- Section for Surgical Research, Department of Surgery, University of Graz, Graz, Austria
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, University of Graz, Graz, Austria
| | - Igor Khatkov
- Department of Surgical Oncology Moscow Clinical Scientific Center, Moscow, Russia
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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11
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Xu SB, Jia CK, Wang JR, Zhang RC, Mou YP. Do patients benefit more from robot assisted approach than conventional laparoscopic distal pancreatectomy? A meta-analysis of perioperative and economic outcomes. J Formos Med Assoc 2018; 118:268-278. [PMID: 29798819 DOI: 10.1016/j.jfma.2018.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/10/2017] [Accepted: 05/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/PURPOSE Robotic approach has improved the ergonomics of conventional laparoscopic distal pancreatectomy (LDP), but whether patients benefit more from robot assisted distal pancreatectomy (RADP) is still controversial. This meta-analysis aims to compare the perioperative and economic outcomes of RADP with LDP. METHODS A systematic review of the literature was carried out on PubMed, EMBASE, and the Cochrane Library between January 1990 and March 2017. All eligible studies comparing RADP versus LDP were included. Perioperative and economic outcomes constituted the end points. RESULTS 13 English studies with 1396 patients were included. Regarding to intraoperative outcomes, RADP was associated with a significant decrease in conversion rate (OR = 0.52; 95%CI: 0.34, 0.78; P = 0.002). Although the spleen-preserving rates were comparable between RADP and LDP, a significant higher splenic vessels conservation rate was observed in the RADP group (OR = 4.71; 95%CI: 1.77, 12.56; P = 0.002). No statistically significant differences were found at operation time, estimated blood loss and blood transfusion rate. Concerning postoperative outcomes, pooled data indicated the overall morbidity, pancreatic fistula and the length of hospital stay did not differ significantly between the RADP and LDP groups. And concerning pathological outcomes, positive margin rate and the number of lymph nodules harvested were comparable between the two groups. The operative cost of RADP was almost double that of LDP (WMD = 2350.2 US dollars; 95%CI: 1165.62, 3534.78; P = 0.0001). CONCLUSION RADP showed a slight technical advantage. But whether this benefit is worth twofold cost should be considered by patient's individuation.
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Affiliation(s)
- Sun-Bing Xu
- Department of Hepatobiliary Pancreatic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou 310006, China.
| | - Chang-Ku Jia
- Department of Hepatobiliary Pancreatic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou 310006, China
| | - Jing-Rui Wang
- Department of Hepatobiliary Pancreatic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou 310006, China
| | - Ren-Chao Zhang
- Department of Gastrointestinal Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
| | - Yi-Ping Mou
- Department of Gastrointestinal Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
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12
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Baiocchi GL, Rosso E, Celotti A, Zimmiti G, Manzoni A, Garatti M, Tiberio G, Portolani N. Laparoscopic pancreatic resections in two medium-sized medical centres. Updates Surg 2018; 70:41-45. [PMID: 29492761 DOI: 10.1007/s13304-018-0520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 02/22/2018] [Indexed: 11/28/2022]
Abstract
To analyze the clinical outcomes of patients undergoing minimally invasive surgery for pancreatic neoplasms, in two medium-volume centers in Northern Italy, a retrospective chart review was performed in the operative registries, searching for patients who had undergone pancreatic surgery via laparoscopy, irrespective of the final pathological nature of the resected neoplasm. For each case, a standard data extraction form was completed and the following data was extracted: age and sex, type of resection, estimated blood loss, length of the operation, number of harvested nodes, post-operative pancreatic fistula, major post-operative complications, mortality and final pathological diagnosis. The systematic literature research was also undertaken and the reported results were analyzed. A total of 55 cases were recorded, including 39 distal pancreatectomies and 16 pancreaticoduodenectomies. The most frequent indications leading to surgery were ductal adenocarcinoma (26 pts) and cystic neoplasm (22 pts). No post-operative death occurred in this series; pancreatic fistula occurred in 64% of distal pancreatectomies and 22% of pancreaticoduodenectomies. The mean operating times were 178' and 572', respectively. Both distal pancreatectomy and pancreaticoduodenectomy proved to be feasible and were safely performed by laparoscopy, in two centers with medium-volume pancreatic caseload.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Edoardo Rosso
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Andrea Celotti
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. .,III Chirurgia-Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Giuseppe Zimmiti
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Manzoni
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Guido Tiberio
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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Hu MG, Xiao YH, Song DD, Zhao GD, Liu YZ, Wang Z, Li HY, Liu R. First experience of robotic spleen-preserving distal pancreatectomy in a child with insulinoma. World J Surg Oncol 2017; 15:199. [PMID: 29121944 PMCID: PMC5680789 DOI: 10.1186/s12957-017-1265-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background An insulinoma is a functional neuroendocrine pancreatic tumor, and surgical resection is indicated. Robot-assisted laparoscopic surgeries have been shown to be generally safe and feasible for treatment of pediatric cases of urologic and digestive disease. Case presentation In July 2016, a 9-year-old girl (24 kg, 120 cm) was admitted with a pancreatic tail insulinoma and underwent robot-assisted spleen-preserving laparoscopic distal pancreatectomy. The total procedure time was 155 min, and the blood loss was about 10 ml. The patient recovered without complications. Conclusions This case supports that robot-assisted spleen-preserving laparoscopic distal pancreatectomy may be safe and feasible in pediatric insulinoma patients.
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Affiliation(s)
- Ming-Gen Hu
- Department of Surgical Oncology (HBP), Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuan-Hong Xiao
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Dong-Da Song
- Department of Surgical Oncology (HBP), Chinese PLA General Hospital, Beijing, 100853, China
| | - Guo-Dong Zhao
- Department of Surgical Oncology (HBP), Chinese PLA General Hospital, Beijing, 100853, China
| | - Yan-Zhe Liu
- Department of Surgical Oncology (HBP), Chinese PLA General Hospital, Beijing, 100853, China
| | - Zheng Wang
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hao-Yu Li
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Rong Liu
- Department of Surgical Oncology (HBP), Chinese PLA General Hospital, Beijing, 100853, China.
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14
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Robotic Enucleation for Benign or Borderline Tumours of the Pancreas: A Retrospective Analysis and Comparison from a High-Volume Centre in Asia. World J Surg 2017; 40:3009-3020. [PMID: 27491323 DOI: 10.1007/s00268-016-3655-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enucleation is increasingly performed for benign or borderline tumours of the pancreas because it is a parenchyma-sparing and less invasive procedure compared to conventional pancreatectomy, which reduces the risk of exocrine and endocrine insufficiency. This study retrospectively evaluated and compared the pre-, intra-, and post-operative clinical characteristics after open and robotic approaches for pancreatic enucleation. METHODS Fifty-six cases of enucleation for benign or borderline tumours of the pancreas treated from March 2010 to July 2015 were identified by a retrospective search. These included 25 patients who underwent an open approach and 31 patients who underwent a robotic approach. The clinical characteristics were extracted and compared. RESULTS The two groups had a similar location and pathology of the tumour. The robotic group had a significantly shorter operation time and significantly less blood loss than the open group. The rates of clinical pancreatic fistula (PF) formation and major complications were similar. The robotic approach could be applied for a tumour on the right side of the pancreas without increasing the incidence of clinical PF or other major complications. The patients with clinical PF had a significantly shorter distance between the lesion and the main pancreatic duct (MPD). CONCLUSION Robotic enucleation appears to be a feasible and safe approach for benign or borderline tumours of the pancreas and was associated with similarly favourable surgical outcomes as the open approach. Identifying and avoiding the MPD is an important step during enucleation.
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One hundred and forty five total laparoscopic pancreatoduodenectomies: A single centre experience. Pancreatology 2017; 17:936-942. [PMID: 28867529 DOI: 10.1016/j.pan.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 07/25/2017] [Accepted: 08/18/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Laparoscopic pancreatoduodenectomy (LPD) remains one of the most challenging minimal invasive operations today. PATIENTS AND METHODS Between January 2007 and December 2016, 197 patients were scheduled for LPD but 162 patients (from January 2007 to July 2016) were analysed in this cohort series. RESULTS Total LPD concerned for 162 patients (five patients did not undergo PD and 12 underwent conversion): standard LPD in 104 patients (66%), and laparoscopic pylorus-preserving PD in 41 patients (26%). Median operative time was 415 (240-765) min. Median blood loss was 200 (50-2100) ml. Twelve patients required blood transfusion. Clinically relevant pancreatic fistula (ISGPF grades B and C) occurred in 21 (13%) patients: 16 (10.0%) grade B, and 5 (3%) grade C. Grades B and C delayed gastric emptying occurred in five patients each. Grades B and C post-pancreatectomy bleeding occurred in 9 (5.7%) and 3 (1.9%) patients, respectively. LPD was performed for 18 (11.4%) benign and 139 (88.5%) malignant lesions. Superior mesenteric and/or portal vein involvement required major venous resection in eight patients. The 90-day mortality 5.0%. The median overall survival for pancreatic ductal adenocarcinoma was 22.5 months. CONCLUSION Morbidity and mortality for LPD are comparable to open procedures rates in the literature. Laparoscopic major venous resection is feasible and safe.
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16
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Cesaretti M, Bifulco L, Costi R, Zarzavadjian Le Bian A. Pancreatic resection in the era of laparoscopy: State of Art. A systematic review. Int J Surg 2017; 44:309-316. [PMID: 28689866 DOI: 10.1016/j.ijsu.2017.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Innovation in surgical devices and improvement in laparoscopic skills have gradually led to achieve more challenging surgical procedures. Among these demanding interventions is the pancreatic surgery that is seen as intraoperatively risky and with high postoperative morbi-mortality rate. In order to understand the complexity of laparoscopic pancreatic surgery, we performed a systematic review of literature. DATA SOURCE A systematic review of literature was performed regarding laparoscopic pancreatic resection. RESULTS Laparoscopic approach in pancreas resections has been extensively reported as safe and feasible regarding pancreaticoduodenectomy, distal pancreatectomy and pancreatic enucleation. Compared to open approach, no benefit in morbi-mortality has been demonstrated (except for laparoscopic distal pancreatectomy) and no controlled randomized trials have been reported. CONCLUSIONS Laparoscopic approach is not workable in all patients and patient selection is not standardized. Additionally, most optimistic reports considering laparoscopic approach are produced by tertiary centres. Currently, two tasks should be accomplished 1°) standardization of the laparoscopic pancreatic procedures 2°) comparative trials to assess endpoint benefits of laparoscopic pancreatic resection compared with open procedures.
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Affiliation(s)
- Manuela Cesaretti
- Service de Chirurgie Hépatique, Pancréatique et Biliaire, Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot-VII, Clichy, 92110, France; Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France
| | - Lelio Bifulco
- Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France
| | - Renato Costi
- Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France; Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, 43100, Italy
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris Descartes - V, Paris, 75006, France.
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Lianos GD, Christodoulou DK, Katsanos KH, Katsios C, Glantzounis GK. Minimally Invasive Surgical Approaches for Pancreatic Adenocarcinoma: Recent Trends. J Gastrointest Cancer 2017; 48:129-134. [PMID: 28326457 DOI: 10.1007/s12029-017-9934-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic resection for cancer represents a real challenge for every surgeon. Recent improvements in laparoscopic experience, minimally invasive surgical techniques and instruments make now the minimally invasive approach a real "triumph." There is no doubt that minimally invasive surgery has replaced with great success conventional surgery in many fields, including surgical oncology. METHODS AND RESULTS However, its progress in pancreatic resection for adenocarcinoma has been dramatically slow. Recent evidence supports the notion that minimally invasive distal pancreatectomy is safe and feasible and that is becoming the procedure of choice mainly for benign or low-grade malignant lesions in the distal pancreas. On the other side, minimally invasive pancreatoduodenectomy has not yet been widely accepted and there is enormous skepticism when applied for pancreatic head adenocarcinoma. In this review, we summarize the current evidence on the potential applications of minimally invasive surgical approaches for this aggressive, heterogeneous, and enigmatic type of cancer. CONCLUSIONS Moreover, the potential future applications of these approaches are discussed with the hope to improve the quality of life as well as the survival rates of pancreatic cancer patients.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece.
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Konstantinos H Katsanos
- Department of Gastroenterology, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Christos Katsios
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
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18
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Walsh RM, Chalikonda S. How I Do It: Hybrid Laparoscopic and Robotic Pancreaticoduodenectomy. J Gastrointest Surg 2016; 20:1650-7. [PMID: 27271540 DOI: 10.1007/s11605-016-3170-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/10/2016] [Indexed: 01/31/2023]
Abstract
Minimally invasive pancreatic resections remain technically challenging. Distal pancreatectomy has been embraced at multiple centers as an acceptable minimally invasive technique in selected patients. In contrast, minimally invasive pancreaticoduodenectomy has not achieved broad acceptance, partly due to technical challenges. We detail a minimally invasive technique that utilizes both laparoscopic and robotic approaches which capitalizes on the advantages of each. Our early results have encouraged the continued development of this minimally invasive pancreatic surgery program. This hybrid technique may be an approach that is useful for surgeons striving to adopt the advantages of minimally invasive surgery for their patients.
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Affiliation(s)
- R Matthew Walsh
- Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A100, Cleveland, OH, 44195, USA.
| | - Sricharan Chalikonda
- Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A100, Cleveland, OH, 44195, USA
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19
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Ronnekleiv-Kelly SM, Javed AA, Weiss MJ. Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes. J Vis Surg 2016; 2:138. [PMID: 29078525 DOI: 10.21037/jovs.2016.07.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/18/2016] [Indexed: 12/20/2022]
Abstract
Recent improvements in imaging techniques and more frequent use of cross-sectional imaging have led to an increase in the identification of benign and low-grade lesions of the pancreas. Patients with resectable cancers are commonly treated by either a Whipple procedure or distal pancreatectomy (DP) based on the location of the tumor. Central pancreatectomy (CP) is a less commonly performed operation that has recently been utilized for resection of these now more frequently diagnosed low-grade and benign lesions located in the mid pancreas. Lesions that may have a relatively more indolent nature include branch-type intraductal papillary mucinous neoplasm (IPMNs), mucinous cystic neoplasms, neuroendocrine tumors, and solid pseudopapillary tumors. The goal of a CP is complete extirpation of the lesion, while preserving pancreatic parenchyma to reduce the risks of developing diabetes and exocrine insufficiency (EI). Although open CP has been shown to be safe and efficacious, the outcomes of a minimally invasive approach are still relatively underreported and therefore unknown. In this paper, we describe our surgical approach to performing a CP with an accompanying video demonstration of the key portions of the operation.
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Affiliation(s)
| | - Ammar A Javed
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Weiss
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Gabriel E, Thirunavukarasu P, Attwood K, Nurkin SJ. National disparities in minimally invasive surgery for pancreatic tumors. Surg Endosc 2016; 31:398-409. [PMID: 27412124 DOI: 10.1007/s00464-016-4987-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/09/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND For patients with pancreatic tumors, several disparities have been shown to impact access to care, including surgery, and subsequently adversely affect long-term oncologic outcomes. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS) across different demographics for pancreatic tumors. METHODS We utilized the American College of Surgeons (ACS) National Cancer Data Base (NCDB) to identify patients with pancreatic tumors from 2010 to 2011 who had undergone surgery through either an open or MIS approach. Multivariable analysis was performed to investigate differences in patient characteristics in relation to surgical approach and conversion to open. RESULTS A total of 2809 patients were identified. The initial surgical approach included 86.5 % open (2430) and 13.5 % MIS (87.6 % were laparoscopic, and 12.4 % were robotic). Tumor histology was significantly associated with MIS, whereby patients with neuroendocrine tumors were more than twice as likely to have an MIS approach compared to adenocarcinoma. Tumor location within the pancreas was also associated with MIS, with tumors in the tail being three times more likely to be removed through MIS compared to tumors in the head. For patients with disease in the body or tail of the pancreas, ethnicity was independently associated with MIS whereby patients of Hispanic origin were less likely to have MIS. The conversion rate to open was 27.7 %, and geographic location was associated with conversion rates. CONCLUSIONS MIS procedures comprise approximately 13.5 % of surgical procedures for pancreatic tumors. In addition to tumor histology, differences in surgical approach were identified with respect to ethnicity for patients with tumors in the body/tail of the pancreas.
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Affiliation(s)
- Emmanuel Gabriel
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Pragatheeshwar Thirunavukarasu
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Steven J Nurkin
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
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21
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Nachmany I, Pencovich N, Ben-Yehuda A, Lahat G, Nakache R, Goykhman Y, Lubezky N, Klausner JM. Laparoscopic Distal Pancreatectomy: Learning Curve and Experience in a Tertiary Center. J Laparoendosc Adv Surg Tech A 2016; 26:470-4. [DOI: 10.1089/lap.2016.0098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ido Nachmany
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Ben-Yehuda
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Richard Nakache
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaacov Goykhman
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Lubezky
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M. Klausner
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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22
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Zhou JY, Xin C, Mou YP, Xu XW, Zhang MZ, Zhou YC, Lu C, Chen RG. Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes. PLoS One 2016; 11:e0151189. [PMID: 26974961 PMCID: PMC4790929 DOI: 10.1371/journal.pone.0151189] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 02/24/2016] [Indexed: 01/26/2023] Open
Abstract
AIM To compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP) and laparoscopic distal pancreatectomy (LDP). METHODS A literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS Seven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups. CONCLUSION RADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required. Core tip To date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.
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Affiliation(s)
- Jia-Yu Zhou
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Chang Xin
- Department Of Hepatobiliary Surgery, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo 315040, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People Hospital, Hangzhou 310016, Zhejiang Province, China
- * E-mail:
| | - Xiao-Wu Xu
- Department of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People Hospital, Hangzhou 310016, Zhejiang Province, China
| | - Miao-Zun Zhang
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Department of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People Hospital, Hangzhou 310016, Zhejiang Province, China
| | - Chao Lu
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Rong-Gao Chen
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Abstract
The surgical management of pancreatic diseases is rapidly evolving, encompassing advances in evidence-driven selection of patients amenable for surgical therapy, preoperative risk stratification, refinements in the technical conduct of pancreatic operations, and quantification of postoperative morbidity. These advances have resulted in dramatic reductions in mortality following pancreatic surgery, particularly at high-volume pancreatic centers. Surgical decision making is complex, and requires an intimate understanding of disease pathobiology, host physiology, technical considerations, and evolving trends. This article highlights key developments in the contemporary surgical management of pancreatic diseases.
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Affiliation(s)
- Jashodeep Datta
- Division of Gastrointestinal Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Charles M Vollmer
- Division of Gastrointestinal Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Kriger AG, Kaldarov AR, Berelavichus SV, Gorin DS, Smirnov AV. Robot-assisted distal pancreatectomy: Technical aspects and results. ACTA ACUST UNITED AC 2016. [DOI: 10.17116/onkolog2016545-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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The role of robotics in widening the range of application of minimally invasive surgery for pancreaticoduodenectomy. Pancreatology 2015; 16:293-4. [PMID: 26774496 DOI: 10.1016/j.pan.2015.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 12/11/2022]
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Zhang T, Wang X, Huo Z, Wen C, Wu Z, Jin J, Cheng D, Chen H, Deng X, Shen B, Peng C. Robot-Assisted Middle Pancreatectomy for Elderly Patients: Our Initial Experience. Med Sci Monit 2015; 21:2851-60. [PMID: 26395335 PMCID: PMC4588669 DOI: 10.12659/msm.895477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the indications, safety, feasibility, and short- and long-term outcomes for elderly patients who underwent robot-assisted middle pancreatectomies (MPs). MATERIAL AND METHODS Ten patients (≥60 years) underwent robot-assisted middle pancreatectomies from 2012 to 2015. The perioperative data, including tumor size, operating time, rate of postoperative pancreatic fistula (POPF), postoperative morbidity, and other parameters, were analyzed. We collected and analyzed the follow-up information. RESULTS The mean age of patients was 64.30 years (range, 60-73 years). The average tumor size was 2.61 cm. The 10 cases were all benign or low-grade malignant lesions. The mean operating time was 175.00 min. The mean blood loss was 113.00 ml with no blood transfusion needed. Postoperative fistulas developed in 5 patients; there were 2 Grade A fistulas and 3 grade B fistulas. There were 3 patients who underwent postoperative complications, including 2 Grade 1 or 2 complications and 1 Grade 3 complication. No reoperation and postoperative mortality occurred. The mean hospital stay was 19.91 days. After a median follow-up of 23 months, new onset of diabetes mellitus developed in 1 patient and none suffered from deterioration of previously diagnosed diabetes or exocrine insufficiency, and no tumor recurrence happened. CONCLUSIONS Robot-assisted middle pancreatectomy was safe and feasible for elderly people. It had low risk of exocrine or endocrine dysfunction and benefited patients' long-term outcomes. Incidence of POPF was relatively high but we could prevent it from resulting in bad outcomes by scientific perioperative care and systemic treatment.
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Affiliation(s)
- Tian Zhang
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Xinjing Wang
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Zhen Huo
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Chenlei Wen
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Zhichong Wu
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Jiabin Jin
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Dongfeng Cheng
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Hao Chen
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Xiaxing Deng
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Baiyong Shen
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Chenghong Peng
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
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