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

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. Keywords Pancreatic ductal adenocarcinoma • Robotic-assisted pancreatoduodenectomy • Open pancreatoduodenectomy • Propensity score matching Open pancreatoduodenectomy (OPD) is the cornerstone in the treatment of pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head or uncinate process, but is associated with significant morbidities [1-4]. Minimally invasive surgery was introduced in 1994 for PDAC patients [5], followed by robotic-assisted pancreatoduodenectomy (RPD) in 2003 [6]. Though technically challenging, RPD has a variety of advantages, including less blood loss, faster recovery, and less postoperative complications [4, 7-12]. However, the long-term oncological outcomes of RPD remain undefined [13-17]. Propensity score matching is a statistical method to minimize bias in retrospective studies [18]. We conducted a retrospective analysis to compare the long-term oncological outcomes between RPD and OPD using propensity scorematching. The primary end point of the study was diseasefree survival (DFS) and overall survival (OS).

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

“…Regarding the effect of minimally invasive PD on DGE development, the findings are inconclusive. National registries [ 37 ] and meta-analyses [ 38 , 39 ] were not able to detect an effect, single-center studies showed different results ( 40 , 41 ). Robotic PD was introduced in our department several years ago, but because its use does not span the whole period, we did not include minimally invasive PD into our analysis.…”

ROBOT‐assisted pancreatoduodenectomy in 300 consecutive cases: Annual trend analysis and propensity score‐matched comparison of perioperative and long‐term oncologic outcomes with the open method

“…14 A recent study based on the National Cancer Database reported that median overall survival times of RAPD and open PD were 22.0 and 21.8 months, respectively, with a similar overall survival between the two groups (P = .755) 16 ; however, it did not limit possible confounding factors for survival, such as the number of retrieved lymph nodes (RAPD vs open PD, 22 ± 12 vs 17 ± 11, P < .001). Another study showed similar survival outcomes between RAPD and open PD using a PSM analysis 17 ; however, the number of retrieved lymph nodes was relatively small (RAPD, 11; IQR, 7-16 vs open PD, 11; IQR, 6-17; P = .622), less than the suggested ≥15 retrieved lymph nodes for curative-intent pancreatectomy to optimize operative benefits. 18 In our study, we performed subgroup stage-matched comparison for each disease entity, including PDAC, distal CBD cancer, AoV cancer, duodenal cancer, and malignant IPMN.…”

Comparisons of short-term and long-term results between laparoscopic between open pancreaticoduodenectomy for pancreatic tumors: A systematic review and meta-analysis

“…Among the 16 included controlled studies about LPD and OPD for the treatment of pancreatic cancer, two were randomized controlled experiments (Palanivelu et al, 2017;Wang et al, 2021), and 14 were retrospective studies (Cho et al, 2009;Bao et al, 2014;Croome et al, 2014;Mendoza et al, 2015;Stauffer et al, 2017;Chapman et al, 2018;Kim et al, 2019;Tan et al, 2019;Choi et al, 2020;El Nakeeb et al, 2020;Han et al, 2020;Kwon et al, 2020;Weng et al, 2021;Zhang et al, 2022), involving a total of 4416 patients, including 1275 in the LPD group and 3141 in the OPD group. See Table 1 for literature characteristics, see Supplementary Table S2 and Supplementary Figures S1, S2 for the quality evaluation of the included studies.…”

“…Among the included studies, a total of 13 articles (Cho et al, 2009;Bao et al, 2014;Croome et al, 2014;Mendoza et al, 2015;Palanivelu et al, 2017;Stauffer et al, 2017;Kim et al, 2019;Tan et al, 2019;Choi et al, 2020;El Nakeeb et al, 2020;Han et al, 2020;Wang et al, 2021;Weng et al, 2021) mentioned the index of operation time. Among them, 907 cases were part of the LPD group and 1355 cases were in the OPD group.…”