Journal Article Multicenter Study Ppublish
PubMed: 40629718 DOI: 10.1002/rcs.70091
Minimally Invasive Spleen-Preserving Distal Pancreatectomy in Obese Patients: Factors Related to Clinically Relevant Pancreatic Fistula.
Int J Med Robot 21(4):e70091
Authors: Fabio Ausania, Filippo Landi, Carolina González-Abós, John B Martinie, Dionisios Vrochides, Matthew Walsh, Shanaz M Hossain, Steven White, Viswakumar Prabakaran, Laleh G Melstrom, Yuman Fong, Giovanni Butturini, Laura Bignotto, Valentina Valle, Yuntao Bing, Dianrong Xiu, Gregorio Di Franco, Francisco Sanchez-Bueno, Nicola de'Angelis, Alexis Laurent, Giuseppe Giuliani, Graziano Pernazza, Alessandro Esposito, Roberto Salvia, Francesca Bazzocchi, Ludovica Esposito, Andrea Pietrabissa, Luigi Pugliese, José Rios, Andrea Coratti, Luca Morelli, Pier C Giulianotti
Affiliations
- Department of HBP Surgery and Transplantation, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
- HPB Surgery Department, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
- Freeman Hospital, NHS, Newcastle-Upon-Tyne, UK.
- Division of Surgical Oncology, Gastrointestinal Disease Team, City of Hope Medical Center, Duarte, California, USA.
- Department of HBP Surgery, P. Pederzoli Hospital, Peschiera del Garda, Italy.
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
- Department of General Surgery, Beijing Third Hospital, Beijing, China.
- Division of Translational and New Technologies in Medicine and Surgery, General Surgery Department, University of Pisa, Pisa, Italy.
- Department of HBP Surgery, Virgen de la Arrixaca Hospital, Murcia, Spain.
- Department of Digestive, HBP Surgery and Liver Transplantation, Henri Mondor Hospital, APHP, Creteil, France.
- Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy.
- General and Robotic Surgery Department, San Giovanni Hospital, Rome, Italy.
- HBP Surgery Department, Policlinico G.B. Rossi Hospital, Verona, Italy.
- Department of HBP Surgery, IRCCS Casa Sollievo Della Sofferenza Hospital, Foggia, Italy.
- Department of HBP Surgery, Policlinico S. Matteo Hospital, Pavia, Italy.
- Department of Clinical Pharmacology, Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Abstract
BACKGROUND
Minimally invasive spleen-preserving distal pancreatectomy (MI-SPDP) provides superior outcomes compared with open surgery, with robotic techniques showing better short-term results than laparoscopic techniques, particularly in obese patients. This study aimed to evaluate the impact of the surgical approach on postoperative pancreatic fistula (POPF) incidence in obese patients undergoing MI-SPDP.
METHODS
A retrospective analysis of obese patients from 16 international centres compared robotic (R-SPDP) and laparoscopic (L-SPDP) approaches. Perioperative outcomes and factors associated with clinically relevant POPF were analysed using univariate and multivariate methods.
RESULTS
Among 130 patients (57L-SPDP, 73R-SPDP), POPF incidence was significantly lower in the robotic group (15.1% vs. 42.1%; p = 0.001). The Comprehensive Complications Index was also lower (8% vs. 15%; p = 0.002). Laparoscopic approach (OR = 4.0), pancreatic body transection (OR = 2.6), and non-stapler stump closure (OR = 3.2) were independently associated with higher POPF rates.
DISCUSSION
Robotic MI-SPDP reduces POPF in obese patients. Transection at the pancreatic neck and stapler-based closure can improve outcomes.
MeSH
Fistula, Incidence, Obesity, Pancreatic Fistula, Spleen, Pancreatectomy