Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy: Propensity Score-matched Analysis
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Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy: Propensity Score-matched Analysis. / 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.
in: ANN SURG, Jahrgang 279, Nr. 4, 01.04.2024, S. 665-670.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy: Propensity Score-matched Analysis
AU - Nickel, Felix
AU - Wise, Philipp A
AU - Müller, Philip C
AU - Kuemmerli, Christoph
AU - Cizmic, Amila
AU - Salg, Gabriel A
AU - Steinle, Verena
AU - Niessen, Anna
AU - Mayer, Philipp
AU - Mehrabi, Arianeb
AU - Loos, Martin
AU - Müller-Stich, Beat P
AU - Kulu, Yakup
AU - Büchler, Markus W
AU - Hackert, Thilo
N1 - Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - OBJECTIVE: 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.BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.
AB - OBJECTIVE: 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.BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.
KW - Humans
KW - Pancreaticoduodenectomy/adverse effects
KW - Robotic Surgical Procedures/adverse effects
KW - Propensity Score
KW - Pancreas/surgery
KW - Postoperative Complications/etiology
KW - Learning Curve
KW - Retrospective Studies
KW - Pancreatic Neoplasms/surgery
KW - Laparoscopy/adverse effects
U2 - 10.1097/SLA.0000000000005981
DO - 10.1097/SLA.0000000000005981
M3 - SCORING: Journal article
C2 - 37389886
VL - 279
SP - 665
EP - 670
JO - ANN SURG
JF - ANN SURG
SN - 0003-4932
IS - 4
ER -