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Ghotbi J, Sahakyan M, Søreide K, Fretland ÅA, Røsok B, Tholfsen T, Waage A, Edwin B, Labori KJ, Yaqub S, Kleive D. Minimally Invasive Pancreatoduodenectomy: Contemporary Practice, Evidence, and Knowledge Gaps. Oncol Ther 2022; 10:301-315. [PMID: 35829933 DOI: 10.1007/s40487-022-00203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Minimally invasive pancreatoduodenectomy has gained popularity throughout the last decade. For laparoscopic pancreatoduodenectomy, some high-level evidence exists, but with conflicting results. There are currently no published randomized controlled trials comparing robotic and open pancreatoduodenectomy. Comparative long-term data for patients with pancreatic ductal adenocarcinoma is lacking to date. Based on the existing evidence, current observed benefits of minimally invasive pancreatoduodenectomy over open pancreatoduodenectomy seem scarce, but retrospective data indicate the safety of these procedures in selected patients. As familiarity with the robotic platform increases, studies have shown an expansion in indications, also including patients with vascular involvement and even indicating favorable results in patients with obesity and high-risk morphometric features. Several ongoing randomized controlled trials aim to investigate potential differences in short- and long-term outcomes between minimally invasive and open pancreatoduodenectomy. Their results are much awaited.
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Affiliation(s)
- Jacob Ghotbi
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Mushegh Sahakyan
- The Intervention Center, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Åsmund Avdem Fretland
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,The Intervention Center, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Bård Røsok
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Tore Tholfsen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Anne Waage
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Center, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Jørgen Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sheraz Yaqub
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dyre Kleive
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
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Murtha-Lemekhova A, Fuchs J, Hoffmann K. Innovation for the Sake of Innovation? How Does Robotic Hepatectomy Compare to Laparoscopic or Open Resection for HCC—A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14143359. [PMID: 35884420 PMCID: PMC9318519 DOI: 10.3390/cancers14143359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Robot-assisted surgery has gained popularity in urology and colorectal surgery. Some benefits claimed are less complications and faster recovery due to a gentler approach. We aimed to evaluate current evidence on robot-assisted surgery in HCC resection in comparison to standard approaches—laparoscopic and open resections through a systematic review and meta-analysis. Robot-assisted resection was comparable to standardly utilized methods in terms of complication rates. Major complications occurred less but liver-specific complications, such as liver dysfunction or biliary leakage, were similar in frequency. Prospective studies are lacking but are needed to evaluate which patients would really benefit from robot-assisted liver surgery. Abstract Robot-assisted hepatectomy is a novel approach to treat liver tumors. HCC is on the rise as the cause of cancer and mortality and is often preceded by cirrhosis. Robot-assisted hepatectomy has been suggested to offer benefits to cirrhotic patients. We aimed to evaluate current evidence for robot-assisted hepatectomy for HCC and compare it to open and laparoscopic approaches. This systematic review and meta-analysis has been conducted in accordance with most recent PRISMA recommendations and the protocol has been registered at PROSPERO (CRD42022328544). There were no randomized controlled trials available and no study focused on cirrhotic patients exclusively. Robot-assisted hepatectomy was associated with less major complications than the laparoscopic approach, but comparable with open hepatectomy. No difference was seen in overall or minor complications, as well as liver specific or infectious complications. Cumulative survivals were similar in robot-assisted hepatectomy and laparoscopic or open approaches. There is a clear lack of evidence to suggest particular benefits for robot-assisted hepatectomy in cirrhotic patients. Otherwise, the robot-assisted approach has similar complication rates as open or laparoscopic methods. Non-industry driven randomized controlled trials are needed to evaluate the efficacy of robot-assisted liver surgery.
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Glatz T, Brinkmann S, Thaher O, Driouch J, Bausch D. Robotische Pankreaschirurgie – Lernkurve und Etablierung. Zentralbl Chir 2022; 147:188-195. [DOI: 10.1055/a-1750-9779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungMinimalinvasive Resektionstechniken zur Behandlung verschiedener Pathologien des Pankreas sind potenziell vorteilhaft für die behandelten Patienten in Bezug auf Rekonvaleszenzzeit und
postoperative Morbidität, stellen jedoch eine besondere technische Herausforderung für den behandelnden Chirurgen dar. Der Einzug der robotischen Technik in die Viszeralchirurgie bietet eine
prinzipielle Möglichkeit zur weitreichenden Verbreitung minimalinvasiver Verfahren in der Pankreaschirurgie.Ziel dieser Arbeit war es, die Entwicklungsmöglichkeiten der robotischen Pankreaschirurgie in Deutschland zu überprüfen. Datengrundlage sind die Qualitätsberichte der Krankenhäuser der
Jahre 2015–2019 kombiniert mit einer selektiven Literaturrecherche.Die Anzahl der vorliegenden Qualitätsberichte reduzierte sich von 2015 bis 2019 von 1635 auf 1594. Im Median führten 96 Kliniken 11–20, 56 Kliniken 21–50 und 15 Kliniken mehr als 50
Pankreaskopfresektionen jährlich durch. Bei den Linksresektionen waren es 35 Kliniken mit 11–20, 14 Kliniken mit 21–50 und 2 Kliniken mit mehr als 50 Eingriffen. Unter Berücksichtigung aller
Kliniken, die 5 oder mehr Linksresektionen pro Jahr durchführen, wurden an nur 29 Kliniken minimalinvasive Verfahren eingesetzt. Der Anteil an laparoskopischen Linksresektionen über 50%
wurde an nur 7 Kliniken beschrieben.Nach Datenlage in der Literatur divergieren die Lernkurven für die robotische Pankreaslinks- und Pankreaskopfresektion. Während die Lernkurve für die robotische Pankreaslinksresektion nach
etwa 20 Eingriffen durchlaufen ist, hat die Lernkurve für die robotische Pankreaskopfresektion mehrere Plateaus, die etwa nach 30, 100 und 250 Eingriffen erreicht werden.Aufgrund der dezentralen Struktur der Pankreaschirurgie in Deutschland scheint ein flächendeckendes Angebot robotischer Verfahren aktuell in weiter Ferne. Insbesondere die Etablierung der
robotischen Pankreaskopfresektion wird zunächst Zentren mit entsprechend hoher Fallzahl vorbehalten bleiben.
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Affiliation(s)
- Torben Glatz
- Chirurgische Klinik, Marien Hospital Herne – Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Sebastian Brinkmann
- Chirurgische Klinik, Marien Hospital Herne – Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Omar Thaher
- Chirurgische Klinik, Marien Hospital Herne – Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Jamal Driouch
- Chirurgische Klinik, Marien Hospital Herne – Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Dirk Bausch
- Chirurgische Klinik, Marien Hospital Herne – Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
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