Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy - Propensity Score-matched Analysis

Objective: The goal of the current study was to investigate the perioperative outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) in a high-volume center. Summary Background Data: Despite RPD’s prospective advantages over OPD, current evidence comparing the two has been limited.and has prompted further investigation. The aim of this study was to compare both approaches while including the learning curve phase for RPD. Methods: A 1:1 propensity score-matched (PSM) analysis of a prospective database of RPD with OPD (2017-2022) at a high-volume center was performed. Main outcomes were overall- and pancreas specific complications. Results: Of 375 patients who underwent PD (OPD n=276, RPD n=99), 180 were included in PSM analysis (90 per group). RPD was associated with less blood loss (500 (300-800) vs. 750 (400-1000)ml; P =0.006) and less total complications (50% vs. 19%; P <0.001). Operative time was longer (453 (408-529) vs. 306 (247-362)min; P <0.001); in patients with ductal adenocarcinoma, fewer lymph nodes were harvested (24 (18-27) vs. 33 (27-39); P <0.001) with RPD versus OPD. There were no significant differences for major complications (38 vs. 47%; P =0.291), reoperation rate (14% vs. 10%; P =0.495), postoperative pancreatic fistula (21% vs. 23%; P =0.858) and patients with textbook outcome (62% vs. 55%; P =0.452). Conclusions: Including the learning phase, RPD can be safely implemented in high-volume settings and shows potential for improved perioperative outcomes versus OPD. Pancreas-specific morbidity was unaffected by the robotic approach. Randomized trials with specifically trained pancreatic surgeons and expanded indication for the robotic approach are needed.