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Multicenter Study
. 2023 Nov;37(11):8384-8393.
doi: 10.1007/s00464-023-10361-x. Epub 2023 Sep 15.

Robotic versus laparoscopic distal pancreatectomy in obese patients

Fabio Ausania  1   2 , Filippo Landi  3   4 , John B Martinie  5 , Dionisios Vrochides  5 , Matthew Walsh  6 , Shanaz M Hossain  6 , Steven White  7 , Viswakumar Prabakaran  7 , Laleh G Melstrom  8 , Yuman Fong  8 , Giovanni Butturini  9 , Laura Bignotto  9 , Valentina Valle  10 , Yuntao Bing  11 , Dianrong Xiu  11 , Gregorio Di Franco  12 , Francisco Sanchez-Bueno  13 , Nicola de'Angelis  14 , Alexis Laurent  14 , Giuseppe Giuliani  15 , Graziano Pernazza  16 , Alessandro Esposito  17 , Roberto Salvia  17 , Francesca Bazzocchi  18 , Ludovica Esposito  18 , Andrea Pietrabissa  19 , Luigi Pugliese  19 , Riccardo Memeo  20 , Ichiro Uyama  21 , Yuichiro Uchida  21 , José Rios  22 , Andrea Coratti  15 , Luca Morelli #  12 , Pier C Giulianotti #  10
Affiliations
Multicenter Study

Robotic versus laparoscopic distal pancreatectomy in obese patients

Fabio Ausania et al. Surg Endosc. 2023 Nov.

Abstract

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.

Keywords: Laparoscopic distal pancreatectomy; Left pancreatic resection; Obesity; Outcomes; Robotic distal pancreatectomy.

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Conflict of interest statement

Fabio Ausania, Filippo Landi, John B. Martinie, Dionisios Vrochides, Matthew Walsh, Shanaz M. Hossain, Steven White, Viswakumar Prabakaran, Laleh G. Melstrom, Yuman Fong, Giovanni Butturini, Laura Bignotto, Valentina Valle, Yuntao Bing, Dianrong Xiu, Gregorio Di Franco, Francisco Sanchez-Bueno, Nicola de'Angelis, Alexis Laurent, Giuseppe Giuliani, Graziano Pernazza, Alessandro Esposito, Roberto Salvia, Francesca Bazzocchi, Ludovica Esposito, Andrea Pietrabissa, Luigi Pugliese, Riccardo Memeo, Ichiro Uyama, Yuichiro Uchida, José Rios, Andrea Coratti, Luca Morelli and Pier C. Giulianotti have no conflicts of interest to declare or financial ties to disclose.

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