Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International, Retrospective, Cohort Study

Abstract

Background Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking. Methods An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010–2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival. Results In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p < 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively. Conclusions In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials.

Robotic versus laparoscopic distal pancreatectomy for pancreatic adenocarcinoma in obese patients

“…Although conversion to open itself should not be considered a complication, it is often associated with a worse perioperative outcome, especially in cases of emergency conversion. 19 While previous publications have shown a higher operative time in RDP, 12 in our study, the operative time was comparable between the two groups for obese patients. This could be explained by the increased benefits of the robotic approach in overcoming the difficulty in these patients.…”

Prince and princesses: The current status of robotic surgery in surgical oncology

“…Multiple studies have found equivalent R0 resection rates between RPD and open pancreaticoduodenectomy (OPD), suggesting one can achieve an adequate oncologic resection robotically. 65,66 An American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database analysis of 498 RPDs and 12 612 OPDs showed that patients who underwent RPD were less likely to have any complication (p = 0.004) or a surgical complication (p = 0.008). 67 This includes a lower rate of clinically relevant postoperative pancreatic fistula (CR-POPF) in RPD, and after PSM, RPD was protective against CR-POPF.…”

“…For distal pancreatectomy, RDP is associated with a significantly lower conversion rate compared to LDP. 65,66,[77][78][79][80] RDP is universally associated with a longer operative time, but with the benefit of higher rates of spleen preservation. 81,82 No statistical differences have been found between RDP and LDP when comparing POPF grade B/C rate, major complications, or blood loss.…”

“…While RCTs investigating RPD remain ongoing, data from large, retrospective cohort studies have supported the use of the robot for pancreaticoduodenectomy. Multiple studies have found equivalent R0 resection rates between RPD and open pancreaticoduodenectomy (OPD), suggesting one can achieve an adequate oncologic resection robotically 65,66 . An American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database analysis of 498 RPDs and 12 612 OPDs showed that patients who underwent RPD were less likely to have any complication ( p = 0.004) or a surgical complication ( p = 0.008) 67 .…”

“…Accordingly, data is limited to retrospective reviews and meta‐analyses. For distal pancreatectomy, RDP is associated with a significantly lower conversion rate compared to LDP 65,66,77–80 . RDP is universally associated with a longer operative time, but with the benefit of higher rates of spleen preservation 81,82 .…”