Robotic-Assisted Versus Laparoscopic Distal Pancreatectomy at a High Volume, Minimally Invasive Center

William B Lyman, MD, Michael Passeri, MD, Amit Sastry, MD, Allyson Cochran, MSPH, David A Iannitti, MD, FACS, Dionisios Vrochides, MD, PhD, FACS, FRCSC, Erin H Baker, MD, FACS, John B Martinie, MD, FACS. Carolinas Medical Center

Background: The robotic-assisted approach to distal pancreatectomy has gained popularity over the past decade with most studies showing comparable results to those of laparoscopic distal pancreatectomy. One limitation to previous studies is that the majority of sampled data is from institutions which still perform a relatively high percentage of open procedures (most well over 50%). In this study we present a comparison of robotic-assisted and laparoscopic distal pancreatectomies at a high volume center where approximately 70% of distal pancreatectomies are performed in minimally invasive fashion.

Methods: We performed a retrospective analysis of prospectively recorded data from a REDCap™ database to identify all minimally invasive distal pancreatectomies from January 2008-June 2017 (n=250). One patient was excluded for undergoing simultaneous HIPEC therapy leaving our total number of minimally invasive distal pancreatectomies at 249. All pathologic margins were analyzed according to the Leeds Pathology Protocol (LEEPP) which results in higher rates of margin positivity than traditional neck margin evaluation. Statistical analysis was performed using STATA® software using a combination of Wilcoxon rank-sum and Pearson’s chi-squared tests.

Results: Of the 249 minimally invasive distal pancreatectomies performed at our institution, 135 were performed laparoscopically, and 114 were performed with robotic-assistance. Females were more likely to undergo a robotic-assisted procedure (p=0.034). Additional demographic variables and indications for procedure were similar between groups [Table 1]. Overall, 22.9% of patients underwent distal pancreatectomy for adenocarcinoma. Splenic preservation occurred more often in the robotic-assisted group (p<0.001), and operative time was shorter in the laparoscopic group (p<0.001). Additional outcomes were similar between groups [Table 2]. Of the 58 total patients with adenocarcinoma, a greater number of lymph nodes was evaluated in the robotic cohort (p=0.039). Additional outcomes in patients with adenocarcinoma were similar [Table 3].

Conclusions: At a high volume minimally invasive center, robotic-assisted and laparoscopic approaches to distal pancreatectomy are reasonable for both benign and malignant disease. While splenic preservation rate is higher in the robotic-assisted group, we are unable to retrospectively determine intention to preserve the spleen preoperatively. While operating room time is longer in the robotic-assisted group, this may be an artifact of higher splenic preservation rates. The greater number of average lymph nodes evaluated for adenocarcinoma in the robotic-assisted group may suggest a more thorough lymph node dissection in the robotic group. In the hands of highly skilled minimally invasive surgeons, both approaches produce similar results with a low overall conversion rate (6.0%).