TY - JOUR
T1 - Robot-assisted and laparoscopic extended left pancreatectomy
T2 - a pan-European multicenter propensity-score matched analysis
AU - Bruna, Caro L.
AU - van Ramshorst, Tess
AU - for the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
AU - van Hilst, Jony
AU - Balduzzi, Alberto
AU - Koerkamp, Bas Groot
AU - Dokmak, Safi
AU - Busch, Olivier R.
AU - Berrevoet, Frederik
AU - Ramera, Marco
AU - Edwin, Bjørn
AU - Boggi, Ugo
AU - Festen, Sebastiaan
AU - Wittel, Uwe A.
AU - Balsells, Joaquim
AU - Sergeant, Gregory
AU - Ferrari, Giovanni
AU - Biesel, Esther A.
AU - Luyer, Misha D.P.
AU - van den Boezem, Peter B.
AU - Lopez-Ben, Santiago
AU - Petrič, Miha
AU - Soonawalla, Zahir
AU - de Wilde, Roeland
AU - Aussilhou, Beatrice
AU - Besselink, Marc G.
AU - Hilal, Mohammad Abu
AU - Rotellar, Fernando
AU - Sutcliffe, Robert P.
AU - Ausania, Fabio
AU - Coratti, Andrea
AU - Bonsing, Bert
AU - Souche, Regis
AU - Lips, Daan
AU - Ricci, Claudio
AU - Keck, Tobias
AU - Salvia, Roberto
AU - Kokkola, Arto
AU - Sousa, Fernanda
AU - Molenaar, I. Quintus
AU - Daams, Freek
AU - van der Schelling, George
AU - Björnsson, Bergthor
AU - Giuliani, Giuseppe
AU - Marino, Marco V.
AU - van Santvoort, Hjalmar
AU - de Kleine, Ruben H.
AU - Pozo, Carlos Domingo Del
AU - Hammoda, Mohammed
AU - Roeyen, Geert
AU - D’Hondt, Mathieu
N1 - Publisher Copyright:
© 2025 The Author(s).
PY - 2025/6/23
Y1 - 2025/6/23
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/105010277280
U2 - 10.1097/SLA.0000000000006812
DO - 10.1097/SLA.0000000000006812
M3 - Article
C2 - 40548584
AN - SCOPUS:105010277280
SN - 0003-4932
JO - Annals of Surgery
JF - Annals of Surgery
M1 - 10.1097/SLA.0000000000006812
ER -