• Annals of surgery · Dec 2023

    Outcomes of Robotic Versus Laparoscopic Pancreatoduodenectomy Following Learning Curves of Surgeons: A Multicenter Study on 2255 Patients.

    • Xiu-Ping Zhang, Shuai Xu, Zhi-Ming Zhao, Guang-Sheng Yu, Bing Han, Xiong Chen, Yun-Tao Ma, Zong-Zhen Xu, Zhao Liu, En-Shan Li, Xiang-Feng Guo, Yuan-Xing Gao, Guo-Dong Zhao, Wan Yee Lau, Jun Liu, and Rong Liu.
    • Faculty of Hepato-Biliary-Pancreatic Surgery, The First Center of Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China.
    • Ann. Surg. 2023 Dec 11.

    ObjectiveThis study aimed to compare robotic pancreatoduodenectomy (RPD) with laparoscopic pancreatoduodenectomy (LPD) in operative and oncologic outcomes.BackgroundPrevious studies comparing RPD with LPD have only been carried out in small, single-center studies with variable quality.MethodsConsecutive patients from nine centers in China who underwent RPD or LPD between 2015 and 2022 were included. A 1:1 propensity score matching (PSM) was used to minimize bias.ResultsOf the 2,255 patients, 1158 underwent RPD and 1097 underwent LPD. Following PSM, 1006 patients were enrolled in each group. The RPD group had significantly shorter operative time (270.0 vs. 305.0 minutes, P<0.001), lower intraoperative blood transfusion rate (5.9% vs. 12.0%, P<0.001), lower conversion rate (3.8% vs. 6.7%, P=0.004), and higher vascular reconstruction rate (7.9% vs. 5.6%, P=0.040) than the LPD group. There were no significant differences in estimated blood loss, postoperative length of stay, perioperative complications, and 90-day mortality. Patients who underwent vascular reconstruction had similar outcomes between the two groups, although they had significantly lower estimated blood loss (300.0 vs. 360.0 mL; P=0.021) in the RPD group. Subgroup analysis on pancreatic ductal adenocarcinoma (PDAC) found no significant differences between the two groups in median recurrence-free survival (14.3 vs. 15.3 mo, P=0.573) and overall survival (24.1 vs. 23.7 mo, P=0.710).ConclusionsIn experienced hands, both RPD and LPD are safe and feasible procedures with similar surgical outcomes. RPD had the perioperative advantage over LPD especially in vascular reconstruction. For PDAC patients, RPD resulted in similar oncological and survival outcomes as LPD.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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