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Observational Study
. 2025 Nov 6;112(11):znaf153.
doi: 10.1093/bjs/znaf153.

Oncological outcome after robot-assisted versus open pancreatoduodenectomy for upfront resectable cancer in the pancreatic head: a nationwide cohort analysis

Julia E Menso  1   2 , Caro L Bruna  1   2 , Mahsoem Ali  2   3 , Bert Bonsing  4 , Koop Bosscha  5 , Lodewijk A A Brosens  6 , Olivier R Busch  1   2 , A Stijn L P Crobach  7 , Freek Daams  2   3 , Wouter Derksen  8 , Maxime J L Dewulf  9 , Michail Doukas  10 , Arantza Fariña Sarasqueta  2   11 , Sebastiaan Festen  12 , Mohammad Abu Hilal  1   13   14 , Ignace H J T de Hingh  15 , Marjolein Y V Homs  16 , Geert Kazemier  2   3 , Daan J Lips  17 , Misha D P Luyer  15 , Vincent E de Meijer  18 , J Sven D Mieog  4 , Wouter W Te Riele  8 , Hjalmar C van Santvoort  8 , George P van der Schelling  19 , Martijn Stommel  20 , Joanne Verheij  2   11 , Roeland F de Wilde  21 , Johanna W Wilmink  2   22 , I Quintus Molenaar  8 , Bas Groot Koerkamp  21 , Lydia G van der Geest  23 , Marc G Besselink  1   2
Affiliations
Observational Study

Oncological outcome after robot-assisted versus open pancreatoduodenectomy for upfront resectable cancer in the pancreatic head: a nationwide cohort analysis

Julia E Menso et al. Br J Surg. .

Abstract

Background: Robot-assisted pancreatoduodenectomy (RPD) aims to enhance postoperative recovery compared to open pancreatoduodenectomy (OPD). Although recent randomized trials confirmed the short-term safety of RPD, they did not confirm superiority or assess oncological safety. This nationwide observational cohort study compares oncological outcome after RPD versus OPD in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and distal cholangiocarcinoma (DCC) without vascular contact.

Methods: All consecutive patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact on preoperative imaging in the Netherlands were included. Data were obtained from the Netherlands Cancer Registry (2016-2023). Primary outcomes were overall survival (OS) and R0-resection rate.

Results: Overall, 1675 patients after pancreatoduodenectomy for upfront resectable PDAC and DCC were included (375 RPD; 1300 OPD). Adjusted median OS was 23 months after RPD versus 22 months after OPD, with comparable 5-year survival rate (23.3% versus 22.4%, HR 0.96 [0.82-1.14], P = 0.665). The R0-resection rate was comparable (57.1% versus 59.7%, P = 0.368). RPD was associated with a shorter hospital stay (median 9 versus 11 days, P < 0.001) and comparable in-hospital/30-day (3.1% versus 2.6%, P = 0.618) and 90-day mortality rate (7.7% versus 6.2%, P = 0.276). In patients with PDAC, no differences in receipt (58.2% versus 58.7%, P = 0.900), time to start (median 54 versus 58 days, P = 0.107), or completion of adjuvant chemotherapy (30.4% versus 30.4%, P = 0.999) were observed.

Conclusions: In this nationwide study, oncological outcome including 5-year survival was comparable between patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact without differences in the use of adjuvant therapy for PDAC.

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Figures

Fig. 1
Fig. 1
Adjusted overall survival estimates in patients undergoing robot-assisted versus open pancreatoduodenectomy Adjusted overall survival per surgical approach (left) and difference in overall survival between approaches (right). RPD, robot-assisted pancreatoduodenectomy; OPD, open pancreatoduodenectomy.
Fig. 2
Fig. 2
Predictors for overall survival in the multivariable model The x-axis represents the independent prognostic value per variable for overall survival in a multivariable model including all potential predictors shown in the figure. A higher chi-square value corresponds to a higher independent prognostic value. ASA PS, ASA performance score; RPD, robot-assisted pancreatoduodenectomy; OPD, open pancreatoduodenectomy; OS, overall survival.
Fig. 3
Fig. 3
Forest plot of the impact of the surgical approach on overall survival per subgroup The forest plot of surgical approach effect (point estimate) on overall survival per subgroup with 95% confidence interval (error bar). Size of the squares are proportional to the number of patients. The interrupted line represents the average treatment effect. RPD, robot-assisted pancreatoduodenectomy; OPD, open pancreatoduodenectomy; PDAC, pancreatic ductal adenocarcinoma; DCC, distal cholangiocarcinoma.
See this image and copyright information in PMC

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