Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study

  • Anouk M L H Emmen
  • Maurice J W Zwart
  • Igor E Khatkov
  • Ugo Boggi
  • Bas Groot Koerkamp
  • Olivier R Busch
  • Olivier Saint-Marc
  • Safi Dokmak
  • I Quintus Molenaar
  • Mathieu D'Hondt
  • Marco Ramera
  • Tobias Keck
  • Giovanni Ferrari
  • Misha D P Luyer
  • Luca Moraldi
  • Benedetto Ielpo
  • Uwe Wittel
  • Francois-Regis Souche
  • Thilo Hackert
  • Daan Lips
  • Mehmet Fatih Can
  • Koop Bosscha
  • Regis Fara
  • Sebastiaan Festen
  • Susan van Dieren
  • Andrea Coratti
  • Ignace De Hingh
  • Michele Mazzola
  • Ulrich Wellner
  • Celine De Meyere
  • Hjalmar C van Santvoort
  • Béatrice Aussilhou
  • Abdallah Ibenkhayat
  • Roeland F de Wilde
  • Emanuele F Kauffmann
  • Pavel Tyutyunnik
  • Marc G Besselink
  • Mohammad Abu Hilal
  • European consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

Abstract

BACKGROUND: The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort.

METHODS: An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009-2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien-Dindo ≥III).

RESULTS: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P < .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P < .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P < .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P < .001), and a higher R0-resection rate (73.2% vs 84.4%; P < .001).

CONCLUSION: This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.

Bibliografische Daten

OriginalspracheEnglisch
ISSN0039-6060
DOIs
StatusVeröffentlicht - 06.2024

Anmerkungen des Dekanats

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

PubMed 38570225