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Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study

Emmen, A.M.L.H.; Zwart, M.J.W.; Khatkov, I.E.; Boggi, U.; Groot Koerkamp, B.; Busch, O.R.; Saint-Marc, O.; Dokmak, S.; Molenaar, I.Q.; D'Hondt, M.; Ramera, M.; Keck, T.; Ferrari, G.; Luyer, M.D.P.; Moraldi, L.; Ielpo, B.; Wittel, U.; Souche, F.-R.; Hackert, T.; Lips, D.; Can, M.F.; Bosscha, K.; Fara, R.; Festen, S.; van Dieren, S.; Coratti, A.; De Hingh, I.; Mazzola, M.; Wellner, U.; De Meyere, C.; van Santvoort, H.C.; Aussilhou, B.éa.; Ibenkhayat, A.; de Wilde, R.F.; Kauffmann, E.F.; Tyut

Surgery 175(6): 1587-1594

2024

ISSN/ISBN: 1532-7361
PMID: 38570225
Accession: 091310374

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Summary
The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009-2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien-Dindo ≥III). Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P < .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P < .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P < .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P < .001), and a higher R0-resection rate (73.2% vs 84.4%; P < .001). This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.

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