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Multicenter Study
. 2023 May;30(5):3023-3032.
doi: 10.1245/s10434-022-13054-2. Epub 2023 Feb 17.

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

Jeffrey W Chen #  1   2 , Tess M E van Ramshorst #  1   2   3 , Sanne Lof  1   2 , Bilal Al-Sarireh  4 , Bergthor Bjornsson  5 , Ugo Boggi  6 , Fernando Burdio  7 , Giovanni Butturini  8 , Riccardo Casadei  9 , Andrea Coratti  10 , Mathieu D'Hondt  11 , Safi Dokmak  12 , Bjørn Edwin  13 , Alessandro Esposito  14 , Jean M Fabre  15 , Giovanni Ferrari  16 , Fadhel S Ftériche  12 , Giuseppe K Fusai  17 , Bas Groot Koerkamp  18 , Thilo Hackert  19 , Asif Jah  20 , Jin-Young Jang  21 , Emanuele F Kauffmann  6 , Tobias Keck  22 , Alberto Manzoni  3 , Marco V Marino  23 , Quintus Molenaar  24 , Elizabeth Pando  25 , Patrick Pessaux  26 , Andrea Pietrabissa  27 , Zahir Soonawalla  28 , Robert P Sutcliffe  29 , Lea Timmermann  30 , Steven White  31 , Vincent S Yip  32 , Alessandro Zerbi  33 , Mohammad Abu Hilal #  34 , Marc G Besselink #  35   36 ; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
Collaborators, Affiliations
Multicenter Study

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

Jeffrey W Chen et al. Ann Surg Oncol. 2023 May.

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.

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Figures

Fig. 1
Fig. 1
A Kaplan-Meier curve of overall survival in patients with resectable pancreatic cancer after robot-assisted distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP). B Kaplan-Meier curve of disease-free interval of patients after robot-assisted distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP)
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References

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