title: Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study.
abstract: BACKGROUND
  Spleen preservation (SP) is beneficial for patients undergoing distal pancreatectomy of benign and borderline tumors; however, the conventional laparoscopy approach (C-LDP) is less effective in controlling splenic vessel bleeding. The benefits of the robotic-assisted approach (RA-LDP) in SP have not been clearly described. This study aimed to evaluate whether a robotic approach could improve SP rate and effectiveness/safety profile of laparoscopic distal pancreatectomy (LDP).
  
  
  METHODS
  Matched for scheduled SP, age, sex, ASA classification, tumor size, tumor location, and pathological type, 69 patients undergoing RA-LDP and 50 undergoing C-LDP between January 2005 and May 2014 were included. Main outcome measures included SP rate, operative time (OT), blood loss, transfusion frequency, morbidity, postoperative hospital stay (PHS), and oncologic safety.
  
  
  RESULTS
  Among matched patients scheduled for SP, RA-LDP was associated with significantly higher overall (95.7 vs. 39.4%) and Kimura SP rates (72.3 vs. 21.2%), shorter OT (median 120 vs. 200 min), less blood loss (median 100 vs. 300 mL), lower transfusion frequency (2.1 vs. 18.2%), and shorter mean PHS (10.2 vs. 14.5 days). Among matched patients scheduled for splenectomy, RA-LDP was associated with similar OT, blood loss, transfusion frequency, and PHS. The two approaches were similar in overall morbidity, frequency of pancreatic fistula, and oncologic outcome among patients undergoing splenectomy for malignant tumors.
  
  
  CONCLUSIONS
  RA-LDP was associated with a significantly better SP rate and reduced OT, blood loss, transfusion requirement, and PHS for patients undergoing SP compared to C-LDP, but offered less benefits for patients undergoing splenectomy.
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.|Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
authors: Shi
authors: S
authors: Chen
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
authors: Qian
authors: Q
authors: Zhan
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.|Department of Hepatobiliary Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
authors: Jiang-zhi
authors: JZ
authors: Chen
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
authors: Jia-bin
authors: JB
authors: Jin
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
authors: Xia-xing
authors: XX
authors: Deng
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
authors: Hao
authors: H
authors: Chen
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China. ruijinsby@163.com.
authors: Bai-yong
authors: BY
authors: Shen
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China. chhpeng@yeah.net.
authors: Cheng-hong
authors: CH
authors: Peng
authors: Department of General Surgery, Research Institute of Pancreatic Disease, Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
authors: Hong-wei
authors: HW
authors: Li
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011184:Postoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D065287:Robotic Surgical Procedures; D013154:Spleen / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Laparoscopic distal pancreatectomy; Matched cohort study; Minimal invasiveness; Robotic assistance; Spleen preservation