Robotic Pancreaticoduodenectomy: Increased Adoption and Improved Outcomes

Abstract

Objective: To compare the rate of postoperative 30-day complications between laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD). Background: Previous studies suggest that minimally invasive pancreaticoduodenectomy (MI-PD)—either LPD or RPD—is noninferior to open pancreaticoduodenectomy in terms of operative outcomes. However, a direct comparison of the two minimally invasive approaches has not been rigorously performed. Methods: Patients who underwent MI-PD were abstracted from the 2014 to 2019 pancreas-targeted American College of Surgeons National Sample Quality Improvement Program (ACS NSQIP) dataset. Optimal outcome was defined as absence of postoperative mortality, serious complication, percutaneous drainage, reoperation, and prolonged length of stay (75th percentile, 11 days) with no readmission. Multivariable logistic regression models were used to compare optimal outcome of RPD and LPD. Results: A total of 1540 MI-PDs were identified between 2014 and 2019, of which 885 (57%) were RPD and 655 (43%) were LPD. The rate of RPD cases/year significantly increased from 2.4% to 8.4% (P=0.008) from 2014 to 2019, while LPD remained unchanged. Similarly, the rate of optimal outcome for RPD increased during the study period from 48.2% to 57.8% (P<0.001) but significantly decreased for LPD (53.5% to 44.9%, P<0.001). During 2018–2019, RPD outcomes surpassed LPD for any complication [odds ratio (OR)=0.58, P=0.004], serious complications (OR=0.61, P=0.011), and optimal outcome (OR=1.78, P=0.001). Conclusions: RPD adoption increased compared with LPD and was associated with decreased overall complications, serious complications, and increased optimal outcome compared with LPD in 2018–2019.

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

“…This study agrees with the findings reported in the recent literature 1,4,6,7,10,24,25 . The median operative time was 7.8 h overall and was significantly longer in the late group than in the early group in this report, with median operative times of 8.4 versus 7.2 h. One possible contributing factor for the longer procedure is more cases of level II and III pancreatic mesopancreas dissections in the late group, because only level I mesopancreas dissections were done at our institute before 2018.…”

“…4,6,8,10,11,[14][15][16]24 A recent study by Khachfe et al comparing 885 RPDs and 655 LPDs concluded that RPD adoption had increased and was associated with decreased overall and serious complications and increased optimal outcomes. 25 The true Achilles' heel of RPD, the high operative costs and the "challenging…”

“…A recent study by Khachfe et al. comparing 885 RPDs and 655 LPDs concluded that RPD adoption had increased and was associated with decreased overall and serious complications and increased optimal outcomes 25 . The true Achilles' heel of RPD, the high operative costs and the “challenging pancreaticoduodenectomy” itself, have limited a wider implementation of this procedure and the accumulation of widespread experience at most single centers 7 …”

Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical‐site wound infection: A meta‐analysis

“…After screening the titles and abstracts, 592 articles that did not meet the inclusion criteria were excluded, leaving 169 articles. After reading the complete text, applying inclusion/exclusion criteria, and assessing data integrity, a total of 18 articles were included, comprising 5985 patients (2553 in the RPD group and 3432 in the LPD group, respectively) 14‐31 . The literature screening process is shown in Figure 1.…”

“…After reading the complete text, applying inclusion/exclusion criteria, and assessing data integrity, a total of 18 articles were included, comprising 5985 patients (2553 in the RPD group and 3432 in the LPD group, respectively). [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The literature screening process is shown in Figure 1. Finally, all included studies were of high quality, and their basic characteristics are presented in Table 1.…”