Perioperative and Oncological Outcomes of Robotic Versus Open Pancreaticoduodenectomy in Low-Risk Surgical Candidates: A Multicenter Propensity Score-Matched Study.

This study aimed to perform a multicenter comparison between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD). Previous comparisons of RPD versus OPD have only been carried out in small, single-center studies of variable quality. 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. 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. RPD was comparable to OPD in feasibility and safety. For patients with PDAC, RPD resulted in similar oncologic and survival outcomes as OPD.

Liu Q ，Zhao Z ，Zhang X ，Wang W ，Han B ，Chen X ，Tan X ，Xu S ，Zhao G ，Gao Y ，Gan Q ，Yuan J ，Ma Y ，Dong Y ，Liu Z ，Wang H ，Fan F ，Liu J ，Lau WY ，Liu R ... -  《-》

Short-term outcomes of robotic versus open pancreaticoduodenectomy in elderly patients: A multicenter retrospective cohort study.

With the advances in surgical techniques and perioperative management, the surgical indications for pancreaticoduodenectomy have been extended to elderly patients. Whether robotic pancreaticoduodenectomy (RPD) is superior to open pancreaticoduodenectomy (OPD) in older patients remains uncertain. Thus, this study aimed to compare perioperative outcomes between RPD and OPD in elderly patients. The demographics and perioperative outcomes of a consecutive series of elderly patients (aged ≥75 years) who underwent RPD or OPD at seven pancreatic centers in China between July 2011 and July 2020 were retrospectively analyzed. Of the 302 patients included in this study, 169 underwent RPD and 133 underwent OPD. The RPD group had a shorter operative time (OT) (264.3 vs. 278.2 min, P = 0.01) and less estimated blood loss (EBL) (100 (50 150) vs. 200 (150 300) mL, P < 0.001) than the OPD group. RPDs in 3 (1.8%) patients were converted to OPD. The postoperative length of stay (LOS) after RPD was significantly shorter than that after OPD (13.0 vs. 17.0 days, P < 0.001). No significant differences were found in the rates of clinically relevant postoperative pancreatic fistula, bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage, major morbidity, reoperation, 90-day readmission, or 90-day mortality between the two groups (P > 0.05). The multivariate logistic regression analysis revealed that type 2 diabetes, chronic obstructive pulmonary disease, postoperative hemorrhage, and cardiac events were independent risk factors for postoperative 90-day mortality. This study demonstrated that RPD was comparable to OPD in terms of safety and feasibility in elderly patients with shorter OT, lower EBL, and shorter postoperative LOS. Surgical approach was not an independent risk factor for 90-day mortality.

Liu Q ，Jiang N ，Tian E ，Li M ，Zhang H ，Zhao G ，Tan X ，Wang W ，Han B ，Yuan J ，Gan Q ，Ma Y ，Zhao Z ，Liu R ... -  《-》

Robotic versus open pancreaticoduodenectomy for distal cholangiocarcinoma: a multicenter propensity score-matched study.

Pancreatoduodenectomy is the only potentially curative treatment for distal cholangiocarcinoma (DCC). In this study, we sought to compare the perioperative and oncological outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) based on a multicenter propensity score-matched study. Consecutive patients with DCC who underwent RPD or OPD from five centers in China between January 2014 and June 2019 were included. A 1:1 propensity score matching (PSM) was performed. Univariable and multivariable Cox regression analyses were used to identify independent prognosis factors for overall survival (OS) and recurrence-free survival (RFS) of these patients. A total of 217 patients and 228 patients underwent RPD and OPD, respectively. After PSM, 180 patients in each group were enrolled. There were no significant differences in operative time, lymph node harvest, intraoperative transfusion, vascular resection, R0 resection, postoperative major morbidity, reoperation, 90-day mortality, and long-term survival between the two groups before and after PSM. Whereas, compared with the OPD group, the RPD group had significantly lower estimated blood loss (150.0 ml vs. 250.0 ml; P < 0.001), and a shorter postoperative length of stay (LOS) (12.0 days vs. 15.0 days; P < 0.001). Multivariable analysis showed carbohydrate antigen 19-9 (CA19-9), R0 resection, N stage, perineural invasion, and tumor differentiation significantly associated with OS and RFS of these patients. RPD was comparable to OPD in feasibility and safety. For patients with DCC, RPD resulted in similar oncologic and survival outcomes as OPD.

Xu S ，Zhang XP ，Zhao GD ，Zou WB ，Zhao ZM ，Hu MG ，Gao YX ，Tan XL ，Liu Q ，Liu R ... -  《-》

A Propensity Score-Matched Analysis of Robotic vs Open Pancreatoduodenectomy on Incidence of Pancreatic Fistula.

McMillan MT ，Zureikat AH ，Hogg ME ，Kowalsky SJ ，Zeh HJ ，Sprys MH ，Vollmer CM Jr ... -  《-》

Robotic pancreaticoduodenectomy decreases the risk of clinically relevant post-operative pancreatic fistula: a propensity score matched NSQIP analysis.

A single-institution study demonstrated robotic pancreaticoduodenectomy (RPD) was protective against clinically-relevant postoperative pancreatic fistula (CR-POPF) compared to open pancreaticoduodenectomy (OPD). We sought to compare the national rate of CR-POPF by approach. Procedure-targeted pancreatectomy Participant User Data File was queried from 2014 to 2017 for all patients undergoing pancreaticoduodenectomy. A modified fistula risk score was calculated and patients were stratified into risk categories. Multivariate logistic regression and propensity score matching was used. The rate of CR-POPF (15.6% vs. 11.9%; p = 0.026) was higher in OPD compared to RPD. On subgroup analysis, OPD had higher CR-POPF in high risk patients (32.9% vs. 19.4%; p = 0.007). On multivariable analysis OPD was a predictor of increased CR-POPF (Odds Ratio [OR] = 1.61 [1.15-2.25]; p = 0.005). Other operative factors associated with increased CR-POPF included soft pancreatic texture (OR = 2.65 [2.27-3.09]; p < 0.001) and concomitant visceral resection (OR = 1.41 [1.03-1.93]; p = 0.031). Increased duct size (reference <3 mm) was predictive of decreased CR-POPF: 3-6 mm (OR = 0.70 [0.61-0.81]; p < 0.001) and ≥6 mm (OR = 0.47 [0.37-0.60]; p < 0.001). Following propensity score matching, RPD continued to be protective against the occurrence of CR-POPF (OR = 1.54 [1.09-2.17]; p = 0.013). This is the largest multicenter study to evaluate the impact of RPD on POPF. It suggests that RPD can be protective against POPF, especially for high risk patients.

Vining CC ，Kuchta K ，Berger Y ，Paterakos P ，Schuitevoerder D ，Roggin KK ，Talamonti MS ，Hogg ME ... -  《-》