Background: Cystic pancreatic lesions are increasingly found incidentally. The present study compares the robotic assisted surgical approach with the open surgery in the surgical management of cystic lesions of the pancreas, with a view to documenting benefits from the more expensive robotic approach. Methods: From April 2010 to April 2017 37 robotic-assisted left sided pancreatectomy (LSP) for lesion of the body/tail of the pancreas were performed, of which 27 were patients with cystic tumors (RAS-group). Baseline features, surgical outcomes and histopathological examination were compared retrospectively with a group of 27 consecutive patients treated with open surgery for the same indication from May 2005 to April 2010, obtained from the institutional prospectively collected database (OS-Group). Results: The spleen-preserving rate was significantly higher in the RAS group (63% vs. 33.3% in the OS-Group, p<0.05). No difference in the post-operative pancreatic fistula and morbidity was found between the two groups. The median postoperative length of hospital stay was significantly shorter in the RAS-group: 8 days (range 3-25) vs. 12 days (range 7-26) in the OS-Group (p<0.01). No conversion to open approach was reported in the RAS-group. Conclusion: The robot-assisted LSP is a safe and effective procedure. The robotic approach significantly increases the spleen preservation rate and reduces the post-operative hospital stay. By reducing the trauma of access, it results in smoother post-operative course and faster recovery, particularly important in patients harbouring cystic pancreatic tumors, in increasing their acceptance for surgery when recommended. Prospective studies are necessary to validate the clinical benefits of robotic approach for LSP.
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