This is the first comparison of a novel laparoscopic robotic-assisted PD with the open PD in a case-matched fashion. Our data demonstrate a significant increase in operative time but decreased length of stay for LRPD. The favorable morbidity following LRPD makes it a reasonable surgical approach for selected patients requiring PD.

These multicenter data during the early learning curve for RA-MIPD do not demonstrate excess anastomotic morbidity compared to open. Further studies are required to determine whether surgeon proficiency and evolving technique improve anastomotic outcomes compared to open.

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Results: Comparing group A and B with reference size of 2 cm, group B contained less symptomatic patients (p = 0.002), lower WHO grade (p < 0.001), lower T stage (p < 0.001), and less LN metastasis (p < 001). Lower WHO group and less LN metastasis are protective of recurrence. There were only 2 recurrence cases (2.8%) in group B, whereas 27 cases (28.4%) in group A (p < 0.001). The DFS was significantly higher in group B (5-DFS; 96.3% vs. 65.9%, p < 0.001). It is worth noting that tumors smaller than 1 cm were all Gr1, T1/2, and LN free. Further, there were no recurrences of death when the tumor size was less than 1 cm. Conclusion: NF-pNETs smaller than 2 cm have significantly lower risk for recurrence, i.e. lower WHO grade, and less LN metastasis. Therefore, size less than 2 cm seems to provide reasonable reference for surveillance. For those who feel unconfident with 2 cm, 1 cm may provide more comfortable reference for surveillance.