Short-term Outcomes After Robot-Assisted vs Open Pancreaticoduodenectomy After the Learning Curve

Abstract

IMPORTANCE Robot-assisted pancreaticoduodenectomy (RPD) has been reported to be safe and feasible. As a new technique, RPD has a learning curve similar to that of other types of minimally invasive pancreatic surgery such as laparoscopic pancreaticoduodenectomy. To our knowledge, no reports exist on the outcomes of open pancreaticoduodenectomy (OPD) and RPD after the learning curve. OBJECTIVE To analyze and evaluate the actual advantages of RPD. DESIGN, SETTING, AND PARTICIPANTS Between May 2010 and December 2018, 450 patients underwent RPD in the Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University in Shanghai, China, a high-volume pancreatic disease center. According to our previous study, an important flexion point in the learning curve is 250 cases. Data on the last 200 RPD cases were collected from January 2017 to December 2018. During that period, 634 patients underwent OPD. These patients were divided into 2 groups, and propensity score matching was used to minimize bias. The demographic data and operative outcomes were collected and analyzed. Analysis began May 2019. EXPOSURES Robot-assisted pancreaticoduodenectomy and OPD. MAIN OUTCOMES AND MEASURES The short-term operative outcomes of RPD and OPD. RESULTS After 1:1 matching, 187 cases of RPD and OPD were recorded. In the RPD group, 78 patients (41.7%) were women, and the mean (SD) age was 60.9 (11.4) years. In the OPD group, 80 patients (42.8%) were women, and the mean (SD) age was 60.1 (10.8) years. Robot-assisted pancreaticoduodenectomy had advantages in operative time (mean [SD], 279.7 [76.3] minutes vs 298.2 [78.3] minutes; P = .02), estimated blood loss (mean [SD], 297.3 [246.8] mL vs 415.2 [497.9] mL; P = .002), and postoperative length of hospital stay (mean [SD], 22.4 [16.7] days vs 26.1 [16.3] days; P = .03). However, there was no significant difference in the R0 resection rate and incidence rate of postoperative complications, such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. The incidence rates of postoperative bleeding and reoperation in the RPD group were similar to those in the OPD group, with no statistically significant difference. CONCLUSIONS AND RELEVANCE After passing the learning curve, RPD had advantages in operative time and blood loss compared with OPD. There were no differences in postoperative complications such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. However, patients recovered more quickly after RPD than after OPD. A prospective randomized clinical trial is needed in the future to verify these results.

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

“…Multivariable analysis also found LAPD was an independent factor of increased OT. Notable major complication rates were observed in both groups, which were consistent with the results of recently published studies by Choi et al and Shi et al [23,24]. In detail, DGE was the main complication detected, which was proven to be one of risk factors for longer LOS [OR = 0.050, 95% CI 0.013-0.191].…”

Safety and efficacy of robot-assisted versus open pancreaticoduodenectomy: a meta-analysis of multiple worldwide centers

“…Nine studies [4,6,8,10,12,15,17,22,25] reported estimated blood loss (EBL). There was a high degree of heterogeneity among the studies (I 2 = 82%, P < 0.00001).…”

“…Six studies [6,12,13,17,18,22] reported the bile leakage rate. There was a low degree of heterogeneity (I 2 = 0%, P = 0.6) among the studies.…”

“…(Figs. 4A) 2.2 Wound infection rate Eight studies [2,6,8,12,17,18,22,23] reported the number of wound infection rate. There was moderate heterogeneity (I 2 = 0%, P = 0.65) among the studies.…”

Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis

“…Five studies 8,36,38,41,52 had the Oxford CEBM www.nature.com/scientificreports/ level of evidence of 2b and 19 studies-2c 28,30,35,37,39,40,[42][43][44][45][46][47][48][49][50][51][53][54][55] . Three studies 8,42,47 were multicenter studies with (5, 8 and 14 included centers), 20 studies 28,30,[35][36][37][38][39][40][41][43][44][45][46][48][49][50][51][52][53][54] were single center studies and one study 34 did not provide this information. Various primary endpoints were reported in seven studies 35,…”