Surgical and Oncological Outcomes of Minimally Invasive Left Pancreatectomy for Pancreatic Cancer: Robotic vs. Laparoscopic Approach

TL;DR

This study compares robotic and laparoscopic left pancreatectomy for pancreatic cancer, finding similar cancer outcomes but differences in surgery time and lymph node results.

Contribution

The study provides a direct comparison of robotic and laparoscopic left pancreatectomy outcomes in pancreatic cancer patients.

Findings

Robotic surgery had longer operative times compared to laparoscopic surgery.

Laparoscopic surgery resulted in more lymph nodes harvested and a higher percentage of positive lymph nodes.

No significant differences were found in cancer-related survival outcomes between the two approaches.

Abstract

Minimally invasive left pancreatectomy, including laparoscopic and robotic approaches, has increasingly become the standard for treating pancreatic cancer, particularly for tumors located in the body and tail of the pancreas. Previous research has indicated that both robotic and laparoscopic surgeries offer advantages such as reduced trauma, shorter hospital stays, and faster patient recovery compared to traditional open surgery. However, cancer-related benefits were unclear. Recent studies confirm that both techniques achieve comparable effectiveness in terms of safety, tumor removal success, and patient survival. These results suggest that neither approach is superior in terms of cancer outcomes, highlighting the need for further research. Clarifying these findings through future studies will help inform surgeon training, guide healthcare policy decisions, and optimize surgical strategies, potentially improving patient outcomes and cost-effectiveness in the treatment of pancreatic cancer.

Objective: This study compares the surgical and oncological outcomes of minimally invasive robotic (RLP) and laparoscopic (LLP) left pancreatectomy in pancreatic cancer (PC) patients. Methods: Data from patients who underwent minimally invasive left pancreatectomy between 2013 and 2023 were analyzed. Two groups were identified: RLP and LLP. Perioperative outcomes were compared, including operative time, blood loss, conversion rate, and postoperative complications. Oncological outcomes included margin status, lymph node retrieval, lymph node status, overall survival (OS), and disease-free survival (DFS). Results: Fifty-four patients were divided into the LLP (n = 39) and RLP (n = 15) groups. The median operative time was shorter for LLP than RLP [260 min vs. 366 min, p = 0.007]. Blood loss and conversion rates were comparable (p > 0.05). In the LLP group, significantly more lymph nodes were harvested (29 vs. 19, p = 0.05), and a higher percentage of positive lymph nodes was noted (72% vs. 40%, p = 0.033). No significant difference was found in the R0 resection status (82% vs. 73%, p = 0.358). After a median follow-up of 26 months, OS (23 months vs. 34 months, p = 0.812) and DFS (17 months vs. 16 months, p = 0.635) were similar. Conclusion: RLP provides outcomes identical to LLP in treating body–tail pancreatic cancer, with further studies needed to confirm its long-term oncological efficacy.

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