Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 16;8(20):33872-33883.
doi: 10.18632/oncotarget.17513.

Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?

Jiaqiang Zhang  1   2 , Jiabin Jin  1 , Shi Chen  1   2 , Jiangning Gu  1   2 , Yi Zhu  1 , Kai Qin  1 , Qian Zhan  1   2 , Dongfeng Cheng  1 , Hao Chen  1   2 , Xiaxing Deng  1   2 , Baiyong Shen  1   2 , Chenghong Peng  1   2
Affiliations

Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?

Jiaqiang Zhang et al. Oncotarget. .

Abstract

Background: The most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive surgery has been increasingly used in pancreatectomy. Initial results in robotic distal pancreatectomy (RDP) have been encouraging. Nonetheless, data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare. The aim of this study was to compare the safety and efficacy of RDP and LDP for PNETs.

Methods: From September 2010 to January 2017, operative parameters and perioperative outcomes in an initial experience with 43 consecutive patients undergoing RDP were collected and compared with those in 31 patients undergoing LDP.

Results: Patients undergoing RDP and LDP demonstrated equivalent age, sex, ASA score, tumor location and tumor size. Operating time, length of resected pancreas, postoperative length of hospital stay and rates of conversion to open, pancreatic fistula, transfusion and reoperation were not statistically different. Patients in the RDP group were associated with significantly higher overall (79.1 vs. 48.4 %, P = 0.006) and Kimura spleen preservation rates (72.1 vs. 16.1%, P < 0.001) and had reduced risk of excessive blood loss (50 vs. 200mL, P < 0.001). Oncological outcomes in this series were superior for the RDP group with more lymph node harvest for G2 and G3 PNETs (3.5 vs. 2, P = 0.034).

Conclusions: Both RDP and LDP are efficacious and safe methods in treating PNETs located in the body or tail of pancreas. Robotic approach offers advantages with less intraoperative blood loss, higher spleen preservation rate and more lymph node harvest. It may be sensible to choose RDP for patients who fit indications for scheduled spleen preservation.

Keywords: PNETs; distal pancreatectomy; laparoscopic surgery; robotic surgery.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

There are no conflicts to disclose.

Figures

Figure 1
Figure 1. Trocar port placement in robotic distal pancreatectomy
C: Camera port (12 mm); R1: No. 1 main operating arm port (8 mm); R2: No. 2 main operating arm port (8 mm); A: Assistant operating port (12 mm); R3: No. 3 auxiliary arm port (8 mm).
Figure 2
Figure 2. Location of trocar ports during laparoscopic distal pancreatectomy
C: Laparoscopic port (12 mm); R1: No. 1 operating port (12 mm); R2: No. 2 operating port (8 mm); R3: No. 3 operating port (12 mm).
Figure 3
Figure 3. Creation of a retropancreatic tunnel during robotic distal pancreatectomy
SV: the splenic vein; SMV: the superior mesenteric vein.
Figure 4
Figure 4. Transection of the pancreas using an Endo-GIA stapler during robotic distal pancreatectomy
Figure 5
Figure 5
Exposure of the splenic artery and vein during spleen-preserving robotic distal pancreatectomy. SA: the splenic artery; SV: the splenic vein.
See this image and copyright information in PMC

References

    1. Marx S, Spiegel AM, Skarulis MC, Doppmann JL, Collins FS, Liotta LA. Multiple endocrine neoplasia type 1: clinical and genetic topics. Ann Intern Med. 1998;129:484–494. - PubMed
    1. Milan SA, Yeo CJ. Neuroendocrine tumors of the pancreas. Curr Opin Oncol. 2012;24:46–55. - PubMed
    1. Zikusoka MN, Kidd M, Eick G, Latich I, Modlin IM. The molecular genetics of gastroenteropancreatic neuroendocrine tumors. Cancer. 2005;104:2292–309. Review. - PubMed
    1. Srirajaskanthan R, Toumpanakis C, Karpathakis A, Marelli L, Quigley AM, Dusmet M, Meyer T, Caplin ME. Surgical management and palliative treatment in bronchial neuroendocrine tumours: a clinical study of 45 patients. Lung Cancer. 2009;65:68–73. - PubMed
    1. Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology. 2008;135:1469–1492. - PMC - PubMed

MeSH terms