Robotic vs open distal pancreatectomy: A multi‐institutional matched comparison analysis

Abstract

Background Pancreatic surgery is still a challenge even in high‐volume centers. Clinically relevant postoperative pancreatic fistula (CR‐POPF) represents the greatest contributor to major morbidity and mortality, especially following pancreatic distal resection. In this study, we compared robotic distal pancreatectomy (RDP) to open distal pancreatectomy (ODP) in terms of CR‐POPF development and analyzed oncologic efficacy of RDP in the subgroup of patients with pancreatic ductal adenocarcinoma (PDAC). Methods We collected data from five high‐volume centers for pancreatic surgery and performed a matched comparison analysis to compare short and long‐term outcomes after ODP or RDP. Patients were matched with a 2:1 ratio according to age, ASA (American Society of Anesthesiologists) score, body mass index (BMI), final pathology, and TNM (Tumour, Node, Metastasis) staging system VIII ed. Results Two hundred and forty‐six patients who underwent 82 RDPs and 164 ODPs were included. No differences were found in the incidence of CR‐POPF. In the PDAC group, median DFS and OS were 10.8 months and 14.8 months in the ODP group and 10.4 months and 15 months in the RDP group, respectively. Conclusions Robotic distal pancreatectomy is a safe surgical strategy for PDAC and incidence of CR‐POPF is equivalent between RDP and ODP. RDP should be considered equivalent to ODP in terms of oncological efficacy when performed in high‐volume and proficient centers.

A comparison of robotic versus laparoscopic distal pancreatectomy: Propensity score matching analysis

“…Subsequent studies including randomized controlled trials would be necessary for further comparisons. Magistri et al 26 reported that RDP is a safe surgical strategy for pancreatic cancer, but there were only 18 cases of RDP in that study. Although studies on the efficacy of laparoscopic radical antegrade modular pancreatosplenectomy have been published, 32,33 there is no research on robotic radical antegrade modular pancreatosplenectomy so far.…”

“…Subsequent studies including randomized controlled trials would be necessary for further comparisons. Magistri et al 26 . reported that RDP is a safe surgical strategy for pancreatic cancer, but there were only 18 cases of RDP in that study.…”

“…At present, however, the rates of RDP are lower than those of LDP, although RDP rates are increasing. The oncological efficacy of RDP performed at high volume centres was reported equivalent to that of open distal pancreatectomy 26 . A recent meta‐analysis suggested that both RDP and LDP are safe for patients with benign and malignant diseases 27 .…”

“…The oncological efficacy of RDP performed at high volume centres was reported equivalent to that of open distal pancreatectomy. 26 A recent metaanalysis suggested that both RDP and LDP are safe for patients with benign and malignant diseases. 27 In addition, a multi-centre cohort study indicated that RDP is safe and feasible, with a low rate of conversion to open surgery, a high spleen preservation rate, adequate operation time, and acceptable morbidity and mortality rates.…”

Is robotic distal pancreatectomy better than laparoscopic distal pancreatectomy after the learning curve? A systematic review and meta-analysis

“…The special anatomy, complicated vascular variations, and various postoperative complications make pancreatic resection a challenging surgical procedure ( 25 ). As minimally invasive surgery development, LDP and RDP have developed rapidly in recent years ( 28 , 29 ). Previous studies have demonstrated that the LDP has the same safety and efficacy as open surgery ( 30 , 31 ).…”