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HPB (Oxford). 2018 Feb;20(2):155-165. doi: 10.1016/j.hpb.2017.08.032. Epub 2017 Sep 29.

Multicenter outcomes of robotic reconstruction during the early learning curve for minimally-invasive pancreaticoduodenectomy.

Author information

1
Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
2
The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, PA, USA.
3
University of Pisa, Pisa, Italy.
4
Departments of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
5
Mayo Clinic, Rochester, MN, USA.
6
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
7
Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: ajmoser@bidmc.harvard.edu.

Abstract

BACKGROUND:

Perceived excess morbidity during the early learning curve of minimally-invasive pancreaticoduodenectomy (MIPD) has limited widespread adoption. It was hypothesized that robot-assisted reconstruction (RA) after MIPD allows anastomotic outcomes equivalent to open pancreaticoduodenectomy (PD).

METHODS:

Intent to treat analysis of centrally audited data accrued during early adoption of RA-MIPD at five centers.

RESULTS:

CUSUM analysis of operating times at each center identified 92 RA-MIPD during the early learning curve. Mean age was 65 ± 12 years with body mass index 25.8 ± 5.0. Surgical indications included malignant (60%) and premalignant (38%) lesions. Median operating time was 504 min (interquartile range 133) with 242 ml median estimated blood loss (IQR 398) and twelve (13%) conversions to open PD. Major complication rate (Clavien-Dindo III/IV) was 24% with 2 (2.2%) deaths and ten (10.9%) reoperations. Nine (9.9%) clinically significant pancreatic fistulae were observed (4 grade B; 5 grade C). Margin negative resection rate for malignancy was 90% (75% for PDA) with mean harvest of 16 ± 8 lymph nodes.

CONCLUSIONS:

These multicenter data during the early learning curve for RA-MIPD do not demonstrate excess anastomotic morbidity compared to open. Further studies are required to determine whether surgeon proficiency and evolving technique improve anastomotic outcomes compared to open.

PMID:
28966031
DOI:
10.1016/j.hpb.2017.08.032
[Indexed for MEDLINE]
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