Application of robotic surgery in pancreatic cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Haijie , ZHANG Yongqiong , JIN Yanwen , ZHOU Rongxing , YE Hui , CHENG Nansheng ,  LI Fuyu

Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R China;

Corresponding author：

LI Fuyu, Email: lfy_74@hotmail.com

Keywords：

pancreatic cancer; robotic surgery; minimally invasive surgery; review

DOI：

10.7507/1007-9424.202006031

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective The aim of this study was to evaluate the safety and feasibility of robot-assisted surgery in pancreatic cancer.Method Recent literatures related to robot-assisted surgery in treatment of pancreatic cancer compared with traditional open surgery or traditional laparoscopic surgery were collected to make an review.Results Compared with the traditional laparoscopic surgery, the robot-assisted surgery was expensive, with the obvious advantages in terms of anastomosis and reconstruction. Compared with the open operation, both robot-assisted pancreaticoduodenectomy and robot-assisted distal pancreatectomy had longer operation time, but the length of hospital stay and intraoperative blood loss were obviously shortened, robot-assisted distal pancreatectomy also had higher spleen preservation rate. Compared with the traditional laparoscopic distal pancreatectomy, the number of lymph node retrieved, R0 resection rate, and splenic preservation rate were also higher in the robot-assisted group. Simultaneously, robot-assisted total pancreatectomy and midsection pancreatectomy were deemed as safe in some high-volume centers.Conclusions Robot-assisted pancreatic cancer surgery is safe and feasible, but many surgeries are restricted to a small number of high-volume medical centers, and most cases selected to undergo robot-assisted surgery are often early stage patients with small tumor size. A lot of efforts should be made and problems should be solved.

Citation： HU Haijie, ZHANG Yongqiong, JIN Yanwen, ZHOU Rongxing, YE Hui, CHENG Nansheng, LI Fuyu. Application of robotic surgery in pancreatic cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(3): 390-396. doi: 10.7507/1007-9424.202006031 Copy

1.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin, 2016, 66(1): 7-30.
2.	赵玉沛. 重视胰腺癌的多学科诊疗. 中华外科杂志, 2016, 54(11): 801-803.
3.	杨尹默, 赵玉沛. 目前胰腺癌外科治疗应重视的几个问题. 中华外科杂志, 2016, 54(6): 401-403.
4.	Kondo N, Murakami Y, Uemura K, et al. Prognostic impact of perioperative serum CA 19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol, 2010, 17(9): 2321-2329.
5.	Ohtsuka T, Nagakawa Y, Toyama H, et al. A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients. J Hepatobiliary Pancreat Sci, 2020, 27(2): 47-55.
6.	Melvin WS, Needleman BJ, Krause KR, et al. Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A, 2003, 13(1): 33-36.
7.	张人超, 金巍巍, 牟一平. 开放、腹腔镜及机器人胰十二指肠切除术评价与合理选择. 中国实用外科杂志, 2016, 36(8): 854-857.
8.	王遥, 杨佳欣. 机器人手术系统在妇科领域的应用. 协和医学杂志, 2019, 10(4): 375-380.
9.	Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc, 2012, 26(9): 2397-2402.
10.	Cunningham KE, Zenati MS, Petrie JR, et al. A policy of omitting an intensive care unit stay after robotic pancreaticoduodenectomy is safe and cost-effective. J Surg Res, 2016, 204(1): 8-14.
11.	Buchs NC, Addeo P, Bianco FM, et al. Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg, 2011, 35(12): 2739-2746.
12.	Zeh HJ, Zureikat AH, Secrest A, et al. Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol, 2012, 19(3): 864-870.
13.	Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc, 2010, 24(7): 1646-1657.
14.	Chen S, Chen JZ, Zhan Q, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc, 2015, 29(12): 3698-3711.
15.	Boone BA, Zenati M, Hogg ME, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg, 2015, 150(5): 416-422.
16.	Boggi U, Napoli N, Costa F, et al. Robotic-assisted pancreatic resections. World J Surg, 2016, 40(10): 2497-2506.
17.	Polanco PM, Zenati MS, Hogg ME, et al. An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions. Surg Endosc, 2016, 30(4): 1523-1529.
18.	Shyr BU, Shyr BS, Chen SC, et al. Operative results and patient satisfaction after robotic pancreaticoduodenectomy. Asian J Surg, 2020, 43(4): 519-525.
19.	Zhou NX, Chen JZ, Liu Q, et al. Outcomes of pancreato-duodenectomy with robotic surgery versus open surgery. Int J Med Robot, 2011, 7(2): 131-137.
20.	Lai EC, Yang GP, Tang CN. Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy–a comparative study. Int J Surg, 2012, 10(9): 475-479.
21.	de Vasconcellos Macedo AL, Schraibman V, Okazaki S, et al. Treatment of intraductal papillary mucinous neoplasms, neuroendocrine and periampullary pancreatic tumors using robotic surgery: a safe and feasible technique. J Robot Surg, 2011, 5(1): 35-41.
22.	Zhao W, Liu C, Li S, et al. Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: a systematic review and meta-analysis. Surg Oncol, 2018, 27(3): 468-478.
23.	Liu R, Wakabayashi G, Palanivelu C, et al. International consensus statement on robotic pancreatic surgery. Hepatobiliary Surg Nutr, 2019, 8(4): 345-360.
24.	Moekotte AL, Rawashdeh A, Asbun HJ, et al. Safe implementation of minimally invasive pancreas resection: a systematic review. HPB (Oxford), 2020, 22(5): 637-648.
25.	Girgis MD, Zenati MS, King JC, et al. Oncologic outcomes after robotic pancreatic resections are not inferior to open surgery. Ann Surg, 2019, [Online ahead of print].
26.	Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg, 2015, 220(1): 18-27.
27.	Xourafas D, Ashley SW, Clancy TE. Comparison of perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy: an analysis of 1 815 patients from the ACS-NSQIP Procedure-Targeted Pancreatectomy Database. J Gastrointest Surg, 2017, 21(9): 1442-1452.
28.	He S, Ding D, Wright MJ, et al. The impact of high body mass index on patients undergoing robotic pancreatectomy: a propensity matched analysis. Surgery, 2020, 167(3): 556-559.
29.	Kang CM, Kim DH, Lee WJ, et al. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc, 2011, 25(6): 2004-2009.
30.	Chen S, Zhan Q, Chen JZ, et al. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc, 2015, 29(12): 3507-3518.
31.	Hong S, Song KB, Madkhali AA, et al. Robotic versus laparoscopic distal pancreatectomy for left-sided pancreatic tumors: a single surgeon’s experience of 228 consecutive cases. Surg Endosc, 2020, 34(6): 2465-2473.
32.	Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg, 2013, 257(1): 128-132.
33.	Duran H, Ielpo B, Caruso R, et al. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot, 2014, 10(3): 280-285.
34.	Stewart CL, Wong P, Selby L, et al. Minimally invasive distal pancreatectomy and the cost of conversion. J Surg Oncol, 2020, 121(4): 670-675.
35.	Huang B, Feng L, Zhao J. Systematic review and meta-analysis of robotic versus laparoscopic distal pancreatectomy for benign and malignant pancreatic lesions. Surg Endosc, 2016, 30(9): 4078-4085.
36.	Zhou JY, Xin C, Mou YP, et al. Robotic versus laparoscopic distal pancreatectomy: a meta-analysis of short-term outcomes. PLoS One, 2016, 11(3): e0151189.
37.	Cirocchi R, Partelli S, Coratti A, et al. Current status of robotic distal pancreatectomy: a systematic review. Surg Oncol, 2013, 22(3): 201-207.
38.	Lai EC, Tang CN. Current status of robot-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a comprehensive review. Asian J Endosc Surg, 2013, 6(3): 158-164.
39.	van Hilst J, Korrel M, de Rooij T, et al. Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol, 2019, 45(5): 719-727.
40.	Guerrini GP, Lauretta A, Belluco C, et al. Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg, 2017, 17(1): 105.
41.	Vicente E, Núñez-Alfonsel J, Ielpo B, et al. A cost-effectiveness analysis of robotic versus laparoscopic distal pancreatectomy. Int J Med Robot, 2020, 16(2): e2080.
42.	Giulianotti PC, Addeo P, Buchs NC, et al. Early experience with robotic total pancreatectomy. Pancreas, 2011, 40(2): 311-313.
43.	徐建威, 展翰翔, 王磊. 胰腺中段切除术及其微创手术技巧. 协和医学杂志, 2019, 10(4): 317-321.
44.	Zureikat AH, Nguyen KT, Bartlett DL, et al. Robotic-assisted major pancreatic resection and reconstruction. Arch Surg, 2011, 146(3): 256-261.
45.	Chen S, Zhan Q, Jin JB, et al. Robot-assisted laparoscopic versus open middle pancreatectomy: short-term results of a randomized controlled trial. Surg Endosc, 2017, 31(2): 962-971.
46.	Zhang T, Wang X, Huo Z, et al. Robot-assisted middle pancreatectomy for elderly patients: our initial experience. Med Sci Monit, 2015, 21: 2851-2860.
47.	Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-559, 559-562.
48.	Hamad A, Novak S, Hogg ME. Robotic central pancreatectomy. J Vis Surg, 2017, 3: 94.
49.	Shi Y, Jin J, Huo Z, et al. An 8-year single-center study: 170 cases of middle pancreatectomy, including 110 cases of robot-assisted middle pancreatectomy. Surgery, 2020, 167(2): 436-441.
50.	Jiang Y, Jin JB, Zhan Q, et al. Robot-assisted duodenum-preserving pancreatic head resection with pancreaticogastrostomy for benign or premalignant pancreatic head lesions: a single-centre experience. Int J Med Robot, 2018, 14(4): e1903.
51.	Esposito A, Balduzzi A, De Pastena M, et al. Minimally invasive surgery for pancreatic cancer. Expert Rev Anticancer Ther, 2019, 19(11): 947-958.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin, 2016, 66(1): 7-30.
2. 赵玉沛. 重视胰腺癌的多学科诊疗. 中华外科杂志, 2016, 54(11): 801-803.
3. 杨尹默, 赵玉沛. 目前胰腺癌外科治疗应重视的几个问题. 中华外科杂志, 2016, 54(6): 401-403.
4. Kondo N, Murakami Y, Uemura K, et al. Prognostic impact of perioperative serum CA 19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol, 2010, 17(9): 2321-2329.
5. Ohtsuka T, Nagakawa Y, Toyama H, et al. A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients. J Hepatobiliary Pancreat Sci, 2020, 27(2): 47-55.
6. Melvin WS, Needleman BJ, Krause KR, et al. Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A, 2003, 13(1): 33-36.
7. 张人超, 金巍巍, 牟一平. 开放、腹腔镜及机器人胰十二指肠切除术评价与合理选择. 中国实用外科杂志, 2016, 36(8): 854-857.
8. 王遥, 杨佳欣. 机器人手术系统在妇科领域的应用. 协和医学杂志, 2019, 10(4): 375-380.
9. Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc, 2012, 26(9): 2397-2402.
10. Cunningham KE, Zenati MS, Petrie JR, et al. A policy of omitting an intensive care unit stay after robotic pancreaticoduodenectomy is safe and cost-effective. J Surg Res, 2016, 204(1): 8-14.
11. Buchs NC, Addeo P, Bianco FM, et al. Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg, 2011, 35(12): 2739-2746.
12. Zeh HJ, Zureikat AH, Secrest A, et al. Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol, 2012, 19(3): 864-870.
13. Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc, 2010, 24(7): 1646-1657.
14. Chen S, Chen JZ, Zhan Q, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc, 2015, 29(12): 3698-3711.
15. Boone BA, Zenati M, Hogg ME, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg, 2015, 150(5): 416-422.
16. Boggi U, Napoli N, Costa F, et al. Robotic-assisted pancreatic resections. World J Surg, 2016, 40(10): 2497-2506.
17. Polanco PM, Zenati MS, Hogg ME, et al. An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions. Surg Endosc, 2016, 30(4): 1523-1529.
18. Shyr BU, Shyr BS, Chen SC, et al. Operative results and patient satisfaction after robotic pancreaticoduodenectomy. Asian J Surg, 2020, 43(4): 519-525.
19. Zhou NX, Chen JZ, Liu Q, et al. Outcomes of pancreato-duodenectomy with robotic surgery versus open surgery. Int J Med Robot, 2011, 7(2): 131-137.
20. Lai EC, Yang GP, Tang CN. Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy–a comparative study. Int J Surg, 2012, 10(9): 475-479.
21. de Vasconcellos Macedo AL, Schraibman V, Okazaki S, et al. Treatment of intraductal papillary mucinous neoplasms, neuroendocrine and periampullary pancreatic tumors using robotic surgery: a safe and feasible technique. J Robot Surg, 2011, 5(1): 35-41.
22. Zhao W, Liu C, Li S, et al. Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: a systematic review and meta-analysis. Surg Oncol, 2018, 27(3): 468-478.
23. Liu R, Wakabayashi G, Palanivelu C, et al. International consensus statement on robotic pancreatic surgery. Hepatobiliary Surg Nutr, 2019, 8(4): 345-360.
24. Moekotte AL, Rawashdeh A, Asbun HJ, et al. Safe implementation of minimally invasive pancreas resection: a systematic review. HPB (Oxford), 2020, 22(5): 637-648.
25. Girgis MD, Zenati MS, King JC, et al. Oncologic outcomes after robotic pancreatic resections are not inferior to open surgery. Ann Surg, 2019, [Online ahead of print].
26. Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg, 2015, 220(1): 18-27.
27. Xourafas D, Ashley SW, Clancy TE. Comparison of perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy: an analysis of 1 815 patients from the ACS-NSQIP Procedure-Targeted Pancreatectomy Database. J Gastrointest Surg, 2017, 21(9): 1442-1452.
28. He S, Ding D, Wright MJ, et al. The impact of high body mass index on patients undergoing robotic pancreatectomy: a propensity matched analysis. Surgery, 2020, 167(3): 556-559.
29. Kang CM, Kim DH, Lee WJ, et al. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc, 2011, 25(6): 2004-2009.
30. Chen S, Zhan Q, Chen JZ, et al. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc, 2015, 29(12): 3507-3518.
31. Hong S, Song KB, Madkhali AA, et al. Robotic versus laparoscopic distal pancreatectomy for left-sided pancreatic tumors: a single surgeon’s experience of 228 consecutive cases. Surg Endosc, 2020, 34(6): 2465-2473.
32. Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg, 2013, 257(1): 128-132.
33. Duran H, Ielpo B, Caruso R, et al. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot, 2014, 10(3): 280-285.
34. Stewart CL, Wong P, Selby L, et al. Minimally invasive distal pancreatectomy and the cost of conversion. J Surg Oncol, 2020, 121(4): 670-675.
35. Huang B, Feng L, Zhao J. Systematic review and meta-analysis of robotic versus laparoscopic distal pancreatectomy for benign and malignant pancreatic lesions. Surg Endosc, 2016, 30(9): 4078-4085.
36. Zhou JY, Xin C, Mou YP, et al. Robotic versus laparoscopic distal pancreatectomy: a meta-analysis of short-term outcomes. PLoS One, 2016, 11(3): e0151189.
37. Cirocchi R, Partelli S, Coratti A, et al. Current status of robotic distal pancreatectomy: a systematic review. Surg Oncol, 2013, 22(3): 201-207.
38. Lai EC, Tang CN. Current status of robot-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a comprehensive review. Asian J Endosc Surg, 2013, 6(3): 158-164.
39. van Hilst J, Korrel M, de Rooij T, et al. Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol, 2019, 45(5): 719-727.
40. Guerrini GP, Lauretta A, Belluco C, et al. Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg, 2017, 17(1): 105.
41. Vicente E, Núñez-Alfonsel J, Ielpo B, et al. A cost-effectiveness analysis of robotic versus laparoscopic distal pancreatectomy. Int J Med Robot, 2020, 16(2): e2080.
42. Giulianotti PC, Addeo P, Buchs NC, et al. Early experience with robotic total pancreatectomy. Pancreas, 2011, 40(2): 311-313.
43. 徐建威, 展翰翔, 王磊. 胰腺中段切除术及其微创手术技巧. 协和医学杂志, 2019, 10(4): 317-321.
44. Zureikat AH, Nguyen KT, Bartlett DL, et al. Robotic-assisted major pancreatic resection and reconstruction. Arch Surg, 2011, 146(3): 256-261.
45. Chen S, Zhan Q, Jin JB, et al. Robot-assisted laparoscopic versus open middle pancreatectomy: short-term results of a randomized controlled trial. Surg Endosc, 2017, 31(2): 962-971.
46. Zhang T, Wang X, Huo Z, et al. Robot-assisted middle pancreatectomy for elderly patients: our initial experience. Med Sci Monit, 2015, 21: 2851-2860.
47. Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-559, 559-562.
48. Hamad A, Novak S, Hogg ME. Robotic central pancreatectomy. J Vis Surg, 2017, 3: 94.
49. Shi Y, Jin J, Huo Z, et al. An 8-year single-center study: 170 cases of middle pancreatectomy, including 110 cases of robot-assisted middle pancreatectomy. Surgery, 2020, 167(2): 436-441.
50. Jiang Y, Jin JB, Zhan Q, et al. Robot-assisted duodenum-preserving pancreatic head resection with pancreaticogastrostomy for benign or premalignant pancreatic head lesions: a single-centre experience. Int J Med Robot, 2018, 14(4): e1903.
51. Esposito A, Balduzzi A, De Pastena M, et al. Minimally invasive surgery for pancreatic cancer. Expert Rev Anticancer Ther, 2019, 19(11): 947-958.

Previous Article
MRI anatomy of rectum and its clinical application in rectal cancer
Next Article
Application and prospect of laparoscopic pancreaticoduodenectomy

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of robotic surgery in pancreatic cancer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content