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Comparative Study
. 2016 Oct;18(10):835-842.
doi: 10.1016/j.hpb.2016.05.003. Epub 2016 Jul 8.

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

Lee M Ocuin  1 , Jennifer L Miller-Ocuin  1 , Stephanie M Novak  1 , David L Bartlett  1 , J Wallis Marsh  2 , Allan Tsung  2 , Kenneth K Lee  1 , Melissa E Hogg  1 , Herbert J Zeh  1 , Amer H Zureikat  3
Affiliations
Comparative Study

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

Lee M Ocuin et al. HPB (Oxford). 2016 Oct.

Abstract

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is an option for T4 tumors of the pancreatic body. We examined the perioperative and oncologic outcomes of open and robotic DP-CAR at a high-volume pancreatic center.

Methods: Retrospective review of all consecutive DP-CARs. Patient demographics, 90-day perioperative outcomes, and disease specific survival were collected.

Results: 30 DP-CARs were performed (11 Robotic, 19 Open). Both groups had similar preoperative/tumor characteristics, and 27 of 28 PDA patients received neoadjuvant chemotherapy. Robotic DP-CAR was associated with decreased OT (316 vs. 476 min), reduced EBL (393 vs. 1736 ml) and lower rates of blood transfusion (0% vs. 54%) (all p < 0.05). No robotic DP-CAR required conversion. Both groups had similar rates of 90-day mortality, major morbidity, LOS, readmission, and receipt of adjuvant therapy. Similarly, both approaches were associated with high R0 resection rates (82% vs. 79%). At a median follow-up of 33 months, median overall survival for the PDA cohort was 35 months, with no difference in the robotic and open approach (33 and 40 months, p = 0.310).

Conclusions: With a median survival approaching 3 years, DP-CAR represents an effective treatment for select patients with locally advanced pancreatic body cancer, regardless of approach.

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Figures

Figure 1
Figure 1
(a) Standard port placement for robotic DP-CAR. (b) Vascular control and stapled transection of the common hepatic artery. (c) Vascular control and stapled transection of the splenic vein just proximal to the junction of the superior mesenteric vein. (d) Robotic-assisted intraoperative ultrasound demonstrating the junction of the aorta, celiac axis, and superior mesenteric artery. (e) Stapled transection of the celiac artery
Figure 2
Figure 2
Kaplan–Meier estimates for overall survival following DP-CAR. (a) Overall survival following DP-CAR for the entire cohort. (b) Overall survival following robotic or open DP-CAR
Figure 3
Figure 3
Kaplan–Meier estimates by margin status (R0/R1) for overall survival following DP-CAR. R0 margin status is defined as no tumor at the inked margin, regardless of distance
See this image and copyright information in PMC

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