Pancreaticoduodenectomy for Benign and Pre-Malignant Pancreatic and Ampullary Disease: Is Robotic Surgery the Better Approach?

Abstract

Background: The robotic platform is increasingly being utilized in pancreatic surgery, yet its overall putative advantages remain to be adjudicated. We hypothesized that the benefits of robotic pancreatic surgery are maximized in benign and premalignant disease, in the setting of friable tissue and small duct. Methods: Retrospective analysis of a single institution pancreatic database of all consecutive patients who underwent pancreaticoduodenectomy (PD) for benign or premalignant conditions between 2010 to 2020. Peri-operative outcomes and long-term complications (> 90 days post-PD) were compared between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD). Results: Two hundred and four (n=204) patients met our inclusion criteria, of which 68 were OPD and 136 RPD. Baseline characteristics were similar between the two groups (Table 1). RPD cohort had more classic Whipple procedure (84.6% vs. 55.9%, p<0.001), shorter operative time (387.80±114.11 vs. 453.79±159.18 minutes, p<0.001), and lesser lymph node yield (21 vs. 20, p=0.011). Post-operatively, RPD cohort had a significantly shorter length of stay (LOS) (7 vs. 10 days, p=0.004), fewer grade B pancreatic fistulas (8.8% vs. 32.3%, p=0.001) and lower 90-day mortality (0.7% vs. 5.9%, p=0.025). Rates of long-term complications were comparable between the two groups, with th exception for a higher small bowel obstruction requiring surgical intervention in the open group (3.1% vs. 0%, p=0.039). Conclusion: This analysis suggest that RPD has lower 90-day mortality, shorter LOS and lower rates of selected complications compared to OPD and suggest a potential role in the treatment of benign and premalignant pancreatic conditions in select populations.