Oncological outcomes of robotic-assisted versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score-matched analysis

Yuanchi Weng,Yusheng Shi,Zhen Huo,Baiyong Shen,Chenghong Peng,Jiabin Jin,Yu Jiang,Xiaxing Deng,Ningzhen Fu

doi:10.1007/s00464-020-07791-2

Abstract

BackgroundRobotic-assisted minimally invasive surgery is associated with worse oncologic outcomes for some but not other types of cancers. We conducted a propensity score-matched analysis to compare oncologic outcomes of robotic-assisted laparoscopic (RPD) vs. open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC).MethodsTreatment-naïve PDAC patients undergoing either RPD or OPD at our hospital between January 2013 and December 2017 were included. Propensity score matching was conducted at a ratio of 1:2. The primary outcome was disease-free survival (DFS) and overall survival (OS).ResultsA total of 672 cases were identified. The propensity score-matched cohort included 105 patients receiving RPD and 210 patients receiving OPD. The 2 groups did not differ in the number of retrieved lymph nodes [11 (7–16) vs. 11 (6–17), P = 0.622] and R0 resection rate (88.6% vs. 89.0%, P = 0.899). There was no statistically significant difference in median DFS (14 [95% CI 11–22] vs. 12 [95% CI 10–14] months (HR 0.94; 95% CI 0.87–1.50; log-rank P = 0.345) and median OS (27 [95% CI 22–35] vs. 20 [95% CI 18–24] months (HR 0.77; 95% CI 0.57–1.04; log-rank P = 0.087) between the two groups. Multivariate COX analysis showed that RPD was not an independent predictor of DFS (HR 0.90; 95% CI 0.68–1.19, P = 0.456) or OS (HR 0.77; 95% CI 0.57–1.05, P = 0.094).ConclusionComparable DFS and OS were observed between patients receiving RPD and OPD. This preliminary finding requires further confirmation with prospective randomized controlled trials.

Highlights

Robotic-assisted minimally invasive surgery is associated with worse oncologic outcomes for some but not other types of cancers
We conducted this retrospective propensity score matched cohort study from a prospective database, and included treatment-naïve pancreatic ductal adenocarcinoma (PDAC) patients who underwent robotic-assisted pancreatoduodenectomy (RPD) or Open pancreatoduodenectomy (OPD) between January 2013 and December 2017 at the Pancreatic Surgery Department of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine
According to previous reports about the important factors associated with the short-term and long-terms outcomes, together with the variables that would affect the outcomes of RPD and OPD, the propensity score was calculated based on the covariates age, sex, body mass index (BMI), abdominal surgery history, American Society of Anesthesiologists (ASA) physical status, CA199, total bilirubin, biliary drainage, tumor size, portal-mesenteric vein resection, year of diagnosis, differentiation, T and N stage, lymphovascular invasion and perineural invasion and adjuvant chemotherapy

Summary

Methods

The study was undertaken according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [19] and in accordance with the latest version of the Declaration of Helsinki. The selection of RPD was based on our surgical team’s suggestion, we provided robotic approach choice for the following patients: (1) Stage I or II PDAC cases without “borderline resectable” lesions; (2) Preoperative serum total bilirubin ≤ 250 μmol/L; (3) Patients less than 90 years old; (4) ASA score I–III; (5) Without complicated major abdominal surgery history; (6) Without contraindication of pneumoperitoneum. According to previous reports about the important factors associated with the short-term and long-terms outcomes, together with the variables that would affect the outcomes of RPD and OPD, the propensity score was calculated based on the covariates age, sex, BMI, abdominal surgery history, ASA physical status, CA199, total bilirubin, biliary drainage, tumor size, portal-mesenteric vein resection, year of diagnosis, differentiation, T and N stage, lymphovascular invasion and perineural invasion and adjuvant chemotherapy.

Results

Conclusions

Compliance with ethical standards