Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy: Propensity Score-matched Analysis

• Published in: Annals of surgery Vol. 279; no. 4; p. 665
• Main Authors: Nickel, Felix, Wise, Philipp A, Müller, Philip C, Kuemmerli, Christoph, Cizmic, Amila, Salg, Gabriel A, Steinle, Verena, Niessen, Anna, Mayer, Philipp, Mehrabi, Arianeb, Loos, Martin, Müller-Stich, Beat P, Kulu, Yakup, Büchler, Markus W, Hackert, Thilo
• Format: Journal Article
• Language: English
• Published: United States 01.04.2024
• Subjects: Humans; Laparoscopy - adverse effects; Learning Curve; Pancreas - surgery; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - adverse effects; Postoperative Complications - etiology; Propensity Score; Retrospective Studies; Robotic Surgical Procedures - adverse effects
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000005981

The goal of the current study was to investigate the perioperative outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) in a high-volume center. Despite RPDs prospective advantages over OPD, current evidence comparing the 2 has been limited and has prompted further investigation. The aim of this study was to compare both approaches while including the learning curve phase for RPD. A 1:1 propensity score-matched analysis of a prospective database of RPD with OPD (2017-2022) at a high-volume center was performed. The main outcomes were overall- and pancreas-specific complications. Of 375 patients who underwent PD (OPD n=276; RPD n=99), 180 were included in propensity score-matched analysis (90 per group). RPD was associated with less blood loss [500 (300-800) vs 750 (400-1000) mL; P =0.006] and more patients without a complication (50% vs 19%; P <0.001). Operative time was longer [453 (408-529) vs 306 (247-362) min; P <0.001]; in patients with ductal adenocarcinoma, fewer lymph nodes were harvested [24 (18-27) vs 33 (27-39); P <0.001] with RPD versus OPD. There were no significant differences for major complications (38% vs 47%; P =0.291), reoperation rate (14% vs 10%; P =0.495), postoperative pancreatic fistula (21% vs 23%; P =0.858), and patients with the textbook outcome (62% vs 55%; P =0.452). Including the learning phase, RPD can be safely implemented in high-volume settings and shows potential for improved perioperative outcomes versus OPD. Pancreas-specific morbidity was unaffected by the robotic approach. Randomized trials with specifically trained pancreatic surgeons and expanded indications for the robotic approach are needed.