Federico Gheza, MD, Alberto Mangano, MD, Mario A Masrur, MD, Pier C Giulianotti, MD. UIC
Introduction: to evaluate the role of robotic assisted surgery as part of an appropriate patient work-up and treatment of IPMN and its consistency in terms of perioperative and long term results. Few reports described singular minimally invasive procedures for IPMN. This study aims to describe a comprehensive, oncologically adequate treatment of IPMN in a minimally invasive unit with an extremely high robotic penetrance.
Methods and procedures: we retrospectively analyze our database of resected IPMN between 2008 and 2017. This case series includes consecutive, unselected patients: all candidates with a preoperative diagnosis of IPMN were approached robotically.
Results: among 142 robot assisted pancreatic resections, we identified 13 patients with IPMN. One was excluded for having less than 6 months follow-up, so 12 patients were included and analyzed. They underwent duodenopancreatectomy in 7 cases, distal pancreatectomy in 4 cases and central pancratectomy in 1. All but one indications followed the most updated available guidelines (Sendai from 2008 to 2012 and Fukoka from 2012to 2017; American Gastroenterology Association guidelines were used for comparison only). One patient was operated even if the guidelines were suggesting to follow up, because of a strong familiar cancer history. The final pathology for this patient was high grade dysplasia. In another patient we were inside Fukoka’s recommendations, but outside AGA guidelines and the final pathology was adenoma in chronic pancreatitis. Postoperative morbidity was 16.7 (2 low grade complications, one grade A pancreatic fistula, now considered a biochemical leakage only) and mortality was zero. One conversions to open surgery occurred only: a DP in Jehowah’s witness with a bulky mass behind the portal vein. The mean follow up was 40 months (range: 10-68), with only one loss to follow up after 12 months for a high grade dysplasia.
Conclusion: in hepatobiliary pancreatic minimally invasive centers the treatment of IPMN can be grant following the same principles of major cancer centers, with comparable results. Large unbiased studies are needed to evaluate if a minimally invasive approach could modify the ratio between operated and surveilled patients
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88521
Program Number: P740
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster