Qu Liu1, Zhiming Zhao, Xiuping Zhang, Wei Wang, Bing Han, Xiong Chen, Xiaodong Tan, Shuai Xu, Guodong Zhao, Yuanxing Gao, Qin Gan, Jianlei Yuan, Yuntao Ma, Ye Dong, Zhonghua Liu, Hailong Wang, Fangyong Fan, Jianing Liu, Wan Yee Lau, Rong Liu. 1. Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China Department of General Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China 1st Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Jiujiang Hospital of Nanchang University, Jiujiang, Jiangxi, China Department of Hepatobiliary and Pancreatic Surgery, People Hospital of Cangzhou city, Cangzhou, Hebei, China Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China Department of Hepatobiliary Surgery, Chifeng Hospital, Chifeng, Inner Mongolia, China Department of Digestive Minimally Invasive Surgery, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China Department of Hepatobiliary and Pancreatic Surgery, People Hospital of Huanghua city, Cangzhou, Hebei, China Department of Thyroid and Pancreatic Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Abstract
OBJECTIVES: This study aimed to perform a multicenter comparison between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD). BACKGROUND: Previous comparisons of RPD versus OPD have only been carried out in small, single-center studies of variable quality. METHODS: Consecutive patients who underwent RPD (n = 1032) or OPD (n = 1154) at 7 centers in China between July 2012 and July 2020 were included. A 1:1 propensity score matching (PSM) was performed. RESULTS: After PSM, 982 patients in each group were enrolled. The RPD group had significantly lower estimated blood loss (EBL) (190.0 vs 260.0 mL; P < 0.001), and a shorter postoperative 1length of hospital stay (LOS) (12.0 (9.0-16.0) days vs 14.5 (11.0-19.0) days; P < 0.001) than the OPD group. There were no significant differences in operative time, major morbidity including clinically relevant postoperative pancreatic fistula (CR-POPF), bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage (PPH), reoperation, readmission or 90-day mortality rates. Multivariable analysis showed R0 resection, CR-POPF, PPH and reoperation to be independent risk factors for 90-day mortality. Subgroup analysis on patients with pancreatic ductal adenocarcinoma (PDAC) (n = 326 in each subgroup) showed RPD had advantages over OPD in EBL and postoperative LOS. There were no significant differences in median disease-free survival (15.2 vs 14.3 months, P = 0.94) or median overall survival (24.2 vs 24.1 months, P = 0.88) between the 2 subgroups. CONCLUSIONS: RPD was comparable to OPD in feasibility and safety. For patients with PDAC, RPD resulted in similar oncologic and survival outcomes as OPD.
OBJECTIVES: This study aimed to perform a multicenter comparison between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD). BACKGROUND: Previous comparisons of RPD versus OPD have only been carried out in small, single-center studies of variable quality. METHODS: Consecutive patients who underwent RPD (n = 1032) or OPD (n = 1154) at 7 centers in China between July 2012 and July 2020 were included. A 1:1 propensity score matching (PSM) was performed. RESULTS: After PSM, 982 patients in each group were enrolled. The RPD group had significantly lower estimated blood loss (EBL) (190.0 vs 260.0 mL; P < 0.001), and a shorter postoperative 1length of hospital stay (LOS) (12.0 (9.0-16.0) days vs 14.5 (11.0-19.0) days; P < 0.001) than the OPD group. There were no significant differences in operative time, major morbidity including clinically relevant postoperative pancreatic fistula (CR-POPF), bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage (PPH), reoperation, readmission or 90-day mortality rates. Multivariable analysis showed R0 resection, CR-POPF, PPH and reoperation to be independent risk factors for 90-day mortality. Subgroup analysis on patients with pancreatic ductal adenocarcinoma (PDAC) (n = 326 in each subgroup) showed RPD had advantages over OPD in EBL and postoperative LOS. There were no significant differences in median disease-free survival (15.2 vs 14.3 months, P = 0.94) or median overall survival (24.2 vs 24.1 months, P = 0.88) between the 2 subgroups. CONCLUSIONS: RPD was comparable to OPD in feasibility and safety. For patients with PDAC, RPD resulted in similar oncologic and survival outcomes as OPD.