Comparison of Postoperative Pancreatic Fistula Rates of Laparoscopic Versus Robotic Pancreaticojejunostomy after Pancreaticoduodenectomy in Soft Pancreas with Small Pancreatic Duct; a Multi-Center Study with a Propensity Score Matching Analysis

Abstract

Introduction: Soft pancreatic texture and small pancreatic duct were well known risk factors of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). This study aims to compare the POPF rates and other surgical outcomes of laparoscopic versus robotic pancreaticojejunostomy(PJ) in risky pancreas. Method: Between October 2012 to June 2020, total of 429 cases of minimally invasive PD were performed by three surgeons in three different institutions. Among those patients, 201 patients with soft pancreas and small pancreatic duct less than 3 mm were included based on preoperative image study and the operative record. Propensity score matching analysis was performed. Results: 118 totally laparoscopic PD, 49 totally robotic PD, and 34 hybrid PD (laparoscopic resection and robotic anastomosis) were performed. 69 patients underwent laparoscopic PJ and 69 patients underwent robotic PJ were selected after propensity score matching. Demographics of the patients were comparable. Pancreatic duct diameter was similar in both groups (1.8±0.4 mm vs 1.8±0.5 mm, p=1.00). Operative time was shorter in RPJ group (456.1±83.2 vs 405.1±75.4, p=<0.01). Incidence of clinically relevant POPF greater than grade B was comparable in laparoscopic and robotic PJ group (14.5 % vs 11.6 %, p=0.80). Biochemical leakage, grade B, and grade C pancreatic fistulas were 46.4%, 14.5% and 0.0% in laparoscopic PJ group, respectively, and 31.9%, 11.6% and 0.0% in robotic PJ group. Conclusions: Risk of POPF of laparoscopic or robotic PJ in soft texture and small duct was comparable by experienced surgeons. Robotic approach may be beneficial saving operative time.