Robotic Surgery for the Treatment of Chronic Pancreatitis: Pain Control, Narcotic Use Reduction and Re-Intervention Rate - Ten Years Followup Retrospective Study

Abstract

Introduction: Surgical treatment of chronic pancreatitis is reserved to patients with intractable pain, pancreatic duct obstruction or suspicion of malignancy. Robotic surgery in this context has proven to be a safe and feasible. The aim of this study was to evaluate the effect of robotic assisted surgery in the context of chronic pancreatitis with regards to pain control, narcotic usage and need for re-intervention. Methods: A retrospective analysis of a prospectively collected divisional database at the University of Illinois Hospital & Health Sciences System was carried out. The primary endpoint was: 1) Evaluation of pre and post-operative pain and narcotic usage. The secondary endpoints were: 1) 10-year overall survival; and 2) ‘Event Free Survival’ (EFS). Results: 37 patients entered the study. The procedures performed were: pancreatic head resection (7), total pancreatectomy (1), hepatico-jejunostomy (6), longitudinal Roux-en-Y pancreato-jejunostomy (4), pancreatogastrostomy (14) and thoracoscopic splanchnicectomy (7). The mean pre and post-operative pain scores were 6.5 and 4.5 respectively (p<0.05, paired Student t-test). Rates of narcotics use pre and post-surgery were 74% and 50% of patients respectively. Re-intervention rates were: 57% for splanchnicectomies, 16% for hepatico-jejunostomies, 35% for pancreatogastrostomies, 1% for pancreatic resections and 25% for Puestow procedures. Splanchnicectomy group was the one to experience the shortest EFS compared to other groups (log-rank test, p<0.05). Conclusions: Robotic surgical treatment is an effective mean to symptoms control in chronic pancreatitis. Amongst the procedures taken into consideration, pancreatic resection, hepatico-jejunostomies and Puestow procedures appear to have the longest lasting beneficial effects