Abstract
Background
The adoption of robotic pancreaticoduodenectomy has increased in recent years for the treatment of pancreatic head tumours and periampullary lesions. Some potential benefits seem to be demonstrated, but the impact of longer perioperative time on ischaemia and autolysis of the surgical specimen has not been analysed. The aim of this study is to evaluate the impact of robotic surgery on histological changes of the surgical specimen occurring during robotic pancreaticoduodenectomy.
Methods
A review of histopathology files was performed for all pancreatic specimens collected at our hospital from January 2022 to March 2024. Both warm ischaemia time (WIT) and cold ischaemia time (CID) were collected. Histological features related to ischaemic damage were evaluated and ischaemic changes in normal pancreatic tissue and pancreatic tumour were graded as absent, mild, moderate and severe. Univariate and multivariate analyses were performed to determine which variables were associated with moderate and severe ischaemia.
Results
Sixty surgical specimens were analysed: 20 open PD, 17 robotic PD with cold ischaemia and 23 robotic PD. Median total WIT was 182 minutes (OPD 57 minutes vs RPD 190 minutes vs RPD-CI 198 minutes; p < 0.001). Median CID was 760 minutes (740–835) in samples stored at 4ºC. Assessment of tumour regression was of poor quality in the specimens with cold ischemia. Univariate analysis showed that longer intraoperative time, male gender and cold ischaemia were associated with pancreatic tissue degradation. In multivariate analysis, cold ischaemia was the only independent factor associated with normal pancreatic tissue and tumour tissue moderate and severe degradation.
Conclusions
Prolonged ischaemia time, especially in the case of cold storage, has a strong effect on the degradation of normal and tumour tissue without affecting tumour staging.