Xourafas D, et al. – In this work, authors sought to assess the ideal clinical circumstances for use and the efficacy of the robot compared to the open or laparoscopic techniques, in terms of perioperative outcomes for distal pancreatectomy (DP). They observed that the open, laparoscopic, and robotic approaches to distal pancreatectomy offer particular advantages for well–selected patients and specific clinicopathological contexts; therefore, clearly demonstrating the most suitable use and superiority of one technique over another remains challenging.

Methods

• Authors analyzed the 2014 ACS-NSQIP procedure-targeted pancreatectomy data for patients undergoing DP.
• They performed comparison regarding demographics and clinicopathological and perioperative variables between the three approaches.
• Outcomes were evaluated using univariate and multivariable analyses.

Results

• 1815 DPs were identified; 921/1815 were open distal pancreatectomies (ODPs), 694/1815 were laparoscopic distal pancreatectomies (LDPs), and 200/1815 were robotic distal pancreatectomies (RDPs).
• The three groups were similar regarding demographics, ASA score, relevant comorbidities, and malignant histology subtype.
• Patients undergoing RDP had lower T-stages of disease (P = 0.0192), longer operations (P = 0.0030), shorter hospital stays (P < 0.0001), and lower postoperative 30-day morbidity (P = 0.0476) in comparison to the ODP group.
• RDPs were longer operations (P < 0.0001) but required fewer concomitant vascular resections (P = 0.0487) and conversions to open surgery (P = 0.0068) when compared to the LDP group.
• Multivariable analysis suggested that neoadjuvant therapy (P = 0.0236), malignant histology (P = 0.0124), pancreatic reconstruction (P = 0.0006), and vascular resection (P = 0.0008) were the strongest predictors of performing an ODP.