Oncological outcomes of robotic-assisted versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score-matched analysis

• DOI: 10.1007/s00464-020-07791-2
• Publication Date: 2020-07-21T15:49:03Z
• Authors: Yuanchi Weng; Yu Jiang; Ningzhen Fu; Jiabin Jin; Yusheng Shi; Zhen Huo; Xiaxing Deng; Chenghong Peng; Baiyong Shen
• Keywords: Article; Pancreaticoduodenectomy; 3. Good health; Pancreatic Neoplasms; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Robotic Surgical Procedures; Humans; Laparoscopy; Prospective Studies; Propensity Score; Carcinoma, Pancreatic Ductal; Retrospective Studies

Abstract Background Robotic-assisted minimally invasive surgery is associated with worse oncologic outcomes for some but not other types of cancers. We conducted a propensity score-matched analysis to compare oncologic outcomes of robotic-assisted laparoscopic (RPD) vs. open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC).

Methods Treatment-naïve PDAC patients undergoing either RPD or OPD at our hospital between January 2013 and December 2017 were included. Propensity score matching was conducted at a ratio of 1:2. The primary outcome was disease-free survival (DFS) and overall survival (OS).

Results A total of 672 cases were identified. The propensity score-matched cohort included 105 patients receiving RPD and 210 patients receiving OPD. The 2 groups did not differ in the number of retrieved lymph nodes [11 (7–16) vs. 11 (6–17), P = 0.622] and R0 resection rate (88.6% vs. 89.0%, P = 0.899). There was no statistically significant difference in median DFS (14 [95% CI 11–22] vs. 12 [95% CI 10–14] months (HR 0.94; 95% CI 0.87–1.50; log-rank P = 0.345) and median OS (27 [95% CI 22–35] vs. 20 [95% CI 18–24] months (HR 0.77; 95% CI 0.57–1.04; log-rank P = 0.087) between the two groups. Multivariate COX analysis showed that RPD was not an independent predictor of DFS (HR 0.90; 95% CI 0.68–1.19, P = 0.456) or OS (HR 0.77; 95% CI 0.57–1.05, P = 0.094).

Conclusion Comparable DFS and OS were observed between patients receiving RPD and OPD. This preliminary finding requires further confirmation with prospective randomized controlled trials.