ROBOT-assisted pancreatoduodenectomy in 300 consecutive cases: Annual trend analysis and propensity score-matched comparison of perioperative and long-term oncologic outcomes with the open method.

Abstract

We previously reported perioperative and oncologic outcomes of robot-assisted pancreatoduodenectomy (RAPD); however, the follow-up period in RAPD was relatively short, and disease-matched survival analyses were lacking. Therefore, this study investigated time trends of perioperative and long-term disease-matched outcomes of RAPD. Annual clinicopathologic outcomes of 328 patients with RAPD between 2015 and 2020 were analyzed and compared with 929 patients with open PD using the propensity score-matched (PSM) analysis based on postoperative pancreatic fistula (POPF) risk and oncologic variables in malignant patients. Robot-assisted pancreatoduodenectomy cases increased from 10 (6.3%) in 2015 to 116 (50.2% of total PD) in 2020, with malignancy proportion increasing from 50.0% to 80.2%. POPF risk-based PSM analysis showed that compared with open PD, RAPD had younger patients (63.7 vs 65.6years, P=.018), longer operation time (339.1 vs 290.0min, P<.001); however, estimated blood loss (P=.275), complications (17.1% vs 18.3%, P=.702), and clinically relevant POPF (9.8% vs 11.1%, P=.584) were similar with shorter postoperative hospital stay (10.8 vs 15.6days, P<.001). In disease and stage-matched malignant patients, R0 resection (93.9% vs 91.2%, P=.376), total retrieved lymph node (18.2 vs 19.9, P=.058), and 5-year survival rate (57.3% vs 60.6%, P=.406) were similar between RAPD and open PD, also in pancreatic cancer patients (31.6% vs 26.3%, P=.068). Robot-assisted pancreatoduodenectomy demonstrated similar perioperative outcomes with earlier recovery and equivalent long-term survival with open PD. RAPD is safe and feasible for periampullary lesions, including pancreatic cancers, and its role will expand in the era of minimally invasive surgery.