Robotic versus laparoscopic distal pancreatectomy in obese patients
Ausania, Fabio (Hospital Clínic i Provincial de Barcelona)
Landi, Filippo (Universitat de Barcelona)
Martinie, John B (Carolinas Medical Center)
Vrochides, Dionisios (Carolinas Medical Center)
Walsh, Matthew (Cleveland Clinic)
Hossain, Shanaz M (Cleveland Clinic)
White, Steven (Freeman Hospital, NHS)
Prabakaran, Viswakumar (Freeman Hospital, NHS)
Melstrom, Laleh G (City of Hope Medical Center (Duarte, Estats Units d'Amèrica))
Fong, Yuman (City of Hope Medical Center (Duarte, Estats Units d'Amèrica))
Butturini, Giovanni (P. Pederzoli Hospital)
Valle, Valentina (University of Illinois at Chicago)
Bing, Yuntao (Beijing Third Hospital)
Xiu, Dianrong (Beijing Third Hospital)
Di Franco, Gregorio (University of Pisa (Pisa, Itàlia))
Sanchez-Bueno, Francisco (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
de'Angelis, Nicola (Henri Mondor Hospital)
Laurent, Alexis (Henri Mondor Hospital)
Giuliani, Giuseppe (Misericordia Hospital)
Pernazza, Graziano (San Giovanni Battista Hospital)
Esposito, Alessandro (Policlinico G.B. Rossi Hospital)
Salvia, Roberto (Policlinico G.B. Rossi Hospital)
Bazzocchi, Francesca (IRCCS Casa Sollievo della Sofferenza Hospital)
Esposito, Ludovica (IRCCS Casa Sollievo della Sofferenza Hospital)
Pietrabissa, Andrea (Policlinico S. Matteo Hospital)
Pugliese, Luigi (Policlinico S. Matteo Hospital)
Memeo, Riccardo (Acquaviva delle Fonti Hospital)
Uyama, Ichiro (Fujita Health University School of Medicine (Toyoake, Japó))
Uchida, Y. (Fujita Health University School of Medicine (Toyoake, Japó))
Ríos, José (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública)
Coratti, Andrea (Misericordia Hospital)
Morelli, Luca (University of Pisa (Pisa, Itàlia))
Giulianotti, Pier C (University of Illinois at Chicago)

Data:	2023
Resum:	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. 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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Left pancreatic resection ; Laparoscopic distal pancreatectomy ; Robotic distal pancreatectomy ; Obesity ; Outcomes
Publicat a:	Surgical endoscopy and other interventional techniques, Vol. 37, Num. 11 (September 2023) , p. 8384-8393, ISSN 1432-2218

DOI: 10.1007/s00464-023-10361-x
PMID: 37715084

10 p, 755.5 KB

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