Robotic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Analysis of surgical outcomes and long-term prognosis in a high-volume center

• Published in: Hepatobiliary & pancreatic diseases international Vol. 22; no. 2; pp. 140 - 146
• Main Authors: Zhang, Xiu-Ping, Xu, Shuai, Zhao, Zhi-Ming, Liu, Qu, Zhao, Guo-Dong, Hu, Ming-Gen, Tan, Xiang-Long, Liu, Rong
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.04.2023; Department of Liver Transplantation and Hepatobiliary Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China; Faculty of Hepato-Biliary-Pancreatic Surgery,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China%Faculty of Hepato-Biliary-Pancreatic Surgery,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China
• Subjects: CA-19-9 Antigen; Carcinoma, Pancreatic Ductal - pathology; Humans; Long-term prognosis; Lymphatic Metastasis; Nomogram; Pancreatic ductal adenocarcinoma; Pancreatic Neoplasms; Pancreatic Neoplasms - pathology; Pancreaticoduodenectomy - adverse effects; Prognosis; Retrospective Studies; Robotic pancreaticoduodenectomy; Robotic Surgical Procedures - adverse effects; Treatment Outcome; Long-term prognosis; Nomogram; Pancreatic ductal adenocarcinoma; Robotic pancreaticoduodenectomy
• ISSN: 1499-3872
• DOI: 10.1016/j.hbpd.2022.09.006

Robotic pancreaticoduodenectomy (RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival (OS), and an online nomogram calculator was developed based on the independent prognostic factors. Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 mL, the median OS was 23.6 months, and the median recurrence-free survival (RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9 (CA19-9) [hazard ratio (HR) = 2.607, 95% confidence interval (CI): 1.560-4.354, P < 0.001], lymph node metastasis (HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately (HR = 3.190, 95% CI: 1.813-5.614, P < 0.001) or poorly differentiated (HR = 5.114, 95% CI: 2.839-9.212, P < 0.001), and Clavien-Dindo grade ≥ III (HR = 1.657, 95% CI: 1.079-2.546, P = 0.021) were independent prognostic factors for OS. The concordance index (C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685 (95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging (8th edition): 0.541 (95% CI: 0.493-0.589) (P < 0.001). This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ III were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.