Impact of Robotic Pancreaticoduodenectomy on Long-term Survival of Pancreatic Ductal Adenocarcinoma Patients

Abstract

Introduction: The overall survival (OS) rate for pancreatic ductal adenocarcinoma (PDAC) patients is low. Comparison of perioperative outcomes have shown clinical advantages of the robotic pancreaticoduodenectomy (RPD) over open pancreaticoduodenectomy (OPD). The long-term survival outcomes of PDAC patients undergoing OPD vs. RPD have not been compared. Methods: The study was a single-center retrospective analysis of consecutive PDAC patients who underwent pancreaticoduodenectomies by single surgeon. Clinical outcomes, tumor characteristics, neoadjuvant and adjuvant therapies and OS were studied between OPD and RPD. Predictive factors that impacts OS were analyzed. Results: A total of 100 (36 OPD vs 64 RPD) patients were treated from 2013 to 2020. In the RPD group, patients had significantly shorter length of stay (mean, 7.02 vs. 10.72 days; P<.0001), longer operative time (mean, 364.22 vs. 202.64 min; P<.0001) and more patients started adjuvant therapy within 6 weeks (49.06% vs 16%; P=0.0061) compared to OPD. The OS for OPD was 20.4 and RPD was 20.3 months (P=0.6745). Overall percentage of patients that survived after 12, 36 and 60 months was 68%, 29% and 20%. A multivariate analysis showed tumor size and discharge to home were associated with improved survival. Conclusion: The OS between RPD and OPD was not statistically different. The factors that appear to impact OS irrespective of the procedure approach are tumor size, 90-day readmissions, adjuvant therapy and discharge disposition. RPD patients did start chemo sooner and had a tendency to complete chemo more often than OPD but these factors did not impact the OS.