The utilization of minimally invasive distal pancreatectomy (MIDP) is increasing, yet debate remains regarding its oncologic safety in the setting of pancreatic adenocarcinoma (PDAC). Herein we present our institutional experience with robotic (RDP), laparoscopic (LDP), and open distal pancreatectomy (ODP) in the setting of PDAC.

Retrospective review of a prospectively collected single institutional database of patients undergoing consecutive ODP, LDP, and RDP for left-sided PDAC between January 2008 and December 2019 at the University of Pittsburgh Medical Center (UPMC) was done. Perioperative and postoperative outcomes were compared using non-parametric testing and Fischer exact or chi-squared testing. Kaplan–Meier survival curves for disease-free survival and overall survival were compared by Log-Rank sum test. Backward Cox-proportional hazard regression analysis was used to determine if the operative approach was an independent predictor of recurrence and overall survival.

Over 12 years, 146 consecutive distal pancreatectomies for PDAC were performed, of which 28.1% ODP, 60.3% RDP, and 11.6% LDP. There were no statistical differences in patients’ baseline characteristics, including gender, comorbidities, prior abdominal surgeries, and AJCC^8th stage (p > 0.05). Postoperatively, there was no difference in the frequency of major complications (p = 0.414), CR-POPF (p = 0.563), or DGE (p = 0.179). The median overall survival was 28.4 months for ODP, 34.6 months for RDP, and 32.5 months for LDP (Log Rank p = 0.914). On multivariate Cox proportional hazard analysis, the surgical approach was not associated with overall survival. This comparative analysis suggests a non-inferiority of RDP platforms, compared to LDP and classic ODP. The merits of MIS pancreatic surgery in the setting of PDAC should be evaluated in future prospective studies with care to analyze RDP outcomes separately from LDP.

微创远端胰腺切除术 (MIDP) 的使用正在增加，但关于其在胰腺腺癌 (PDAC) 中的肿瘤学安全性仍存在争议。在此，我们介绍了我们在 PDAC 设置中使用机器人 (RDP)、腹腔镜 (LDP) 和开放式远端胰腺切除术 (ODP) 的机构经验。

对 2008 年 1 月至 2019 年 12 月在匹兹堡大学医学中心 (UPMC) 进行的左侧 PDAC 连续 ODP、LDP 和 RDP 患者的前瞻性收集的单一机构数据库进行了回顾性审查。围手术期和术后结果使用非参数检验和 Fischer 精确或卡方检验进行比较。无病生存期和总生存期的 Kaplan-Meier 生存曲线通过对数秩和检验进行比较。使用反向 Cox 比例风险回归分析来确定手术方法是否是复发和总生存期的独立预测因素。

12 年来，连续进行了 146 次 PDAC 远端胰腺切除术，其中 28.1% ODP、60.3% RDP 和 11.6% LDP。患者的基线特征无统计学差异，包括性别、合并症、既往腹部手术和 AJCC ⁸期（p  > 0.05）。术后，主要并发症 ( p  = 0.414)、CR-POPF ( p  = 0.563) 或 DGE ( p  = 0.179)的频率没有差异。ODP 的中位总生存期为 28.4 个月，RDP 为 34.6 个月，LDP 为 32.5 个月（Log Rank p = 0.914）。在多变量 Cox 比例风险分析中，手术方法与总生存率无关。这种比较分析表明，与 LDP 和经典 ODP 相比，RDP 平台具有非劣性。在未来的前瞻性研究中，应评估 MIS 胰腺手术在 PDAC 中的优点，并仔细分析 RDP 结局与 LDP 分开。