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Which one is better? Laparoscopic versus robotic reconstruction in the remnant soft pancreas with a small pancreatic duct following pancreaticoduodenectomy: a multicenter study with propensity score matching analysis

Authors
 Jae Young Jang  ;  Chang Moo Kang  ;  Hyeyeon Kim  ;  Munseok Choi  ;  Jae Hoon Lee  ;  Sung Hoon Choi 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.37(5) : 4028-4039, 2023-05 
Journal Title
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN
 0930-2794 
Issue Date
2023-05
MeSH
Humans ; Laparoscopy* / methods ; Pancreas / surgery ; Pancreatic Ducts / surgery ; Pancreatic Fistula / surgery ; Pancreaticoduodenectomy / adverse effects ; Pancreaticoduodenectomy / methods ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology ; Postoperative Complications / surgery ; Propensity Score ; Retrospective Studies ; Robotic Surgical Procedures* / adverse effects
Keywords
Laparoscopic ; Pancreati fistula ; Pancreaticoduodenectomy ; Robotic ; Soft pancreas
Abstract
Background: Evidence of the advantages of robotic pancreaticoduodenectomy (RPD) over laparoscopic pancreaticoduodenectomy (LPD) is limited. Thus, this study aimed to compare the surgical outcomes of laparoscopic reconstruction L-recon) versus robotic reconstruction (R-recon) in patients with soft pancreas and small pancreatic duct.

Method: Among 429 patients treated with minimally invasive pancreaticoduodenectomy (MIPD) between October 2012 and June 2020 by three surgeons at three institutions, 201 patients with a soft pancreas and a small pancreatic duct (< 3 mm) were included in this study.

Results: Sixty pairs of patients who underwent L-recon and R-recon were selected after propensity score matching. The perioperative outcomes were comparable between the reconstruction approaches, with comparable clinically relevant postoperative pancreatic fistula (CR-POPF) rates (15.0% [L-recon] vs. 13.3% [R-recon]). The sub-analysis according to the type of MIPD procedure also showed comparable outcomes, but only a significant difference in postoperative hospital stay was identified. During the learning curve analysis using the cumulative summation by operation time (CUSUMOT), two surgeons who performed both L-recon and R-recon procedures reached their first peak in the CUSUMOT graph earlier for the R-recon group than for the L-recon group (i.e., 20th L-recon case and third R-recon case of surgeon A and 43rd L-recon case and seventh R-recon case of surgeon B). Surgeon C, who only performed R-recon, demonstrated the first peak in the 22nd case. The multivariate regression analysis for risk factors of CR-POPF showed that the MIPD procedure type, as well as other factors, did not have any significant effect.

Conclusion: Postoperative pancreatic fistula rates and the overall perioperative outcomes of L-recon and R-recon were comparable in patients with soft-textured pancreas and small pancreatic duct treated by experienced surgeons.
Full Text
https://link.springer.com/article/10.1007/s00464-022-09602-2
DOI
10.1007/s00464-022-09602-2
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Choi, Munseok(최문석) ORCID logo https://orcid.org/0000-0002-9844-4747
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/195489
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