Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy

TY - JOUR

T1 - Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy

T2 - 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 -