Abstract
Background
Minimally Invasive Pancreatic Enucleation, either laparoscopic or robot-assisted,
is rarely performed. The aim of this study was to offer the current available evidence
about the outcomes of minimally invasive pancreatic enucleations and explore the possible
advantage of this approach over traditional surgery.
Methods
PubMed (MEDLINE), Cochrane Library and Embase (ELSEVIER) medical databases were searched
for articles published from January 1990 to March 2022. Studies which included more
than 10 cases of minimally-invasive pancreatic enucleation were included. Data on
the outcomes were synthetized and meta-analyzed when appropriate.
Results
Twenty studies published between 2009 and 2022 with a total of 552 patients were included
in the systematic review: three hundred fifty-one patients (63.5%) had a laparoscopic
intervention, two hundred and one (36.5%) robot-assisted with a cumulative incidence
of conversion rate of 5%.
Minimally-invasive surgery was performed in 63% of cases on the body/tail of the Pancreas
and in 37% of the cases on the head/uncinate process of the Pancreas. The cumulative
post-operative 30 days - mortality rate was 0.2% and the major postoperative morbidity
(Clavien-Dindo III-IV-V) 35%. Clinically relevant pancreatic fistula was observed
in 17% of the patients.
Compared with the standardized open approach (n: 366 patients), mean length of hospital
stay was significantly reduced in patients undergoing minimally invasive pancreatic
enucleation (2.45 days, p = 0.003) with a favorable trend for post-operative major
morbidity (Clavien-Dindo III-IV) (- 24% RR, p: 0.13). Operative time, blood loss and
clinically relevant pancreatic fistula rate were comparable between the two groups.
One hundred and fourteen robot-assisted enucleations entered in a subgroup analysis
with comparable results to open surgery.
Conclusion
Minimally-Invasive approach for pancreatic enucleation is safe, feasible and offers
short-term clinical outcomes comparable with open surgery. The potential benefit of
robotic surgery will need to be verified in further studies.
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Article info
Publication history
Published online: February 23, 2023
Accepted:
February 20,
2023
Received:
May 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
