COMPARISON BETWEEN DIFFERENT STRATEGIES FOR THE PANCREATIC STUMP MANAGEMENT DURING ROBOT-ASSISTED DISTAL PANCREATECTOMY

Background: Several technical improvements have decreased morbidity and mortality after distal pancreatectomy. However, postoperative pancreatic fistula (POPF) represents the most feared complication, and the ideal strategy for pancreatic stump management is still undetermined. This study aims to compare the operative and short-term outcomes of patients who underwent robot-assisted distal pancreatectomy (RADP) with the use of the new endo-wrist staplers, the traditional laparoscopic ones, and those in which a selective ligation of Wirsung duct was performed. Methods: We collected data of 66 patients undergone RADP from April 2010 to July 2019: 21 with the use of the new robotic endo-wrist stapler (RobSTAP group), 22 with a traditional laparoscopic endostapler (TradSTAP group) and 23 in which a selective ligation of Wirsung duct with manual suture of the pancreatic stump was performed (WirsLIG group). The peri-operative variables and the short-term outcomes were analyzed and compared. Results: There were no significant differences in mean operative time (243±62 min RobSTAP group, 221±71 min TradSTAP group, 287±130 min WirsLIG group, p=0.07), rates of intra-operative complications and median hospital stay (7 days, range 4-26 days, RobSTAP group, 7 days, range 3-24 days, TradSTAP group, 8 days, range 5-25 days, WirsLIG group; p=0.82). POPF occurred in 2/21 (9,52%) patients (grade B) of RobSTAP group, 1/22 (4,76%) patient (grade B) of TradSTAP group and 4/23 (17,39%) patients (3 grade B and 1 grade C) of WirsLIG group. No need to convert to laparoscopy or laparotomy was recorded. The amount of bleeding was negligible in all groups. No intraoperative or 30-days mortality was observed. Conclusion Despite the major incidence of POPF in WirsLIG group, no statistically significant differences were found respect to the two stapled groups. These data do not allow to clearly support the superiority of a technique for the pancreatic stump management during a robotic distal pancreatectomy.