Long-term oncologic outcomes of robot-assisted pancreaticoduodenectomy versus open pancreaticoduodenectomy for pancreatic cancer

Abstract

Background: Robot-assisted pancreaticoduodenectomy (RPD) has been gaining attention for its potential benefits in short-term surgical outcomes compared with open pancreaticoduodenectomy (OPD) in pancreatic cancer. However, the evidence of its long-term oncological efficacy is limited.

Methods: This retrospective study compared the long-term outcomes of RPD and OPD in patients with pancreatic cancer at Seoul National University Hospital between January 2015 and October 2023. Patients with stage III or IV disease and those who underwent open surgery were excluded. Propensity score matching (PSM) at a 1:2 ratio was performed based on sex, age, the American Society of Anesthesiologists (ASA) class, and initial resectability. The primary outcomes were overall survival (OS) and disease-free survival (DFS), and the secondary outcomes were postoperative recovery and complication rates.

Results: In total, 522 patients (82 RPD and 440 OPD) were reviewed, and 82 RPD and 164 matched OPD patients were analyzed after PSM. The mean age was 64.8 years in the RPD and 65.2 years in the matched OPD group; there were 51.2% male patients in the RPD and 52.4% in the OPD groups. After PSM, patients with RPDs showed better OS and DFS (5-year OS 58.2% vs. 32.3%, P = 0.001; 5-year DFS: 44.6% vs. 24.7%, P = 0.005). The R0 resection rates and harvested lymph node (LN) number were also comparable (RPD versus OPD: R0 resection rate 92.7% versus 90.9%, P = 0.809; harvested LNs 20.0 ± 7.3 versus 23.1 ± 11.5, P = 0.090). Additionally, patients with RPD had a shorter postoperative recovery time and relatively higher adjuvant therapy completion rate, although the difference was only marginally significant (91.6% vs. 75.4%, P = 0.062).

Conclusion: RPD is a feasible alternative to OPD, with potential advantages of early recovery without compromising long-term outcomes after PSM. However, further prospective studies are required to confirm these findings.

Keywords: Adjuvant therapy; Long-term outcomes; Open pancreaticoduodenectomy; Pancreatic cancer; Robot-assisted pancreaticoduodenectomy.

Fig. 1

Flow chart of patient selection

Fig. 2

Trends in the number of RPD and OPD cases for PDAC over time in SNUH. RPD Robot-assisted pancreaticoduodenectomy, OPD open pancreaticoduodenectomy, PDAC Pancreatic ductal adenocarcinoma, SNUH Seoul National University Hospital

Fig. 3

Kaplan–Meier curves of overall survival for RPD and OPD before PSM (A), after PSM (B). PSM propensity score matching, RPD robot-assisted pancreaticoduodenectomy, OPD open pancreaticoduodenectomy

Fig. 4

Kaplan–Meier curves of disease-free survival for RPD and OPD before PSM (A), after PSM (B). RPD robot-assisted pancreaticoduodenectomy, OPD open pancreaticoduodenectomy, PSM propensity score matching