Robot-assisted and Laparoscopic Extended Left Pancreatectomy: A Pan-European Multicenter Propensity-score Matched Analysis

Abstract

Objective: To compare postoperative outcomes after extended robot-assisted left pancreatectomy (e-RLP) and extended laparoscopic left pancreatectomy (e-LLP).

Summary background data: The implementation of RLP is increasing worldwide with expanding indications, resulting in more extended resections. However, the use of e-RLP has not been investigated before.

Methods: International study including consecutive patients after e-RLP and e-LLP for all indications in 19 European countries (2012-2022). Extended resection was defined according to the ISGPS definition. Propensity score matching (PSM) was performed in a 1:1 ratio with a caliper width of 0.1. Primary endpoint was major morbidity (Clavien-Dindo grade ≥III complications).

Results: Overall, 514 patients were included from 72 centers (152 e-RLPs; 362 e-LLPs). Before PSM, e-RLP patients had more tail tumors (69.4% vs 50.0%, P=0.001), vascular involvement (30.3% vs 16.3%, P<0.001) and >2 additional organ resections (28.5% vs 10.7%, P<0.001), with comparable major morbidity rates (27.0% vs 27.0%, P=0.991) and a lower conversion rate (15.1% vs 23.5%, P=0.033), compared to e-LLP. After PSM, 119 e-RLP patients were matched to 119 e-LLP patients. No significant differences were observed in major morbidity (23.5% vs 26.5%, P=0.599), blood loss (200 vs 150 mL, P=0.835), conversion rate (16.0% vs 20.0%, P=0.422), 30-day/in-hospital mortality (1.7% vs 3.4%, P=0.408), and hospital stay (median 7 vs 7 days, P=0.906). E-RLP had longer operative times (median 277 vs 228 min, P<0.001).

Conclusions: This pan-European cohort study found no significant differences in the outcomes among matched patients undergoing e-RLP and e-LLP, although e-RLP was associated with a longer operative time. The robot-assisted approach is used for more extensive resections with a comparable major morbidity rate compared to laparoscopy.

Keywords: distal pancreatectomy; extended resections; left pancreatectomy; minimally invasive distal pancreatectomy; minimally invasive surgery; postoperative pancreatic fistula.