Perioperative Outcomes of Robotic Pancreaticoduodenectomy: a Propensity-Matched Analysis to Open and Laparoscopic Pancre
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ORIGINAL ARTICLE
Perioperative Outcomes of Robotic Pancreaticoduodenectomy: a Propensity-Matched Analysis to Open and Laparoscopic Pancreaticoduodenectomy A. Floortje van Oosten 1,2 & Ding Ding 1 & Joseph R. Habib 1 & Ahmer Irfan 1 & Ryan K. Schmocker 1 & Elisabetta Sereni 1 & Benedict Kinny-Köster 1 & Michael Wright 1 & Vincent P. Groot 1,2 & I. Quintus Molenaar 1,2 & John L. Cameron 1 & Martin Makary 1 & Richard A. Burkhart 1 & William R. Burns 1 & Christopher L. Wolfgang 1 & Jin He 1 Received: 17 June 2020 / Accepted: 6 November 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Introduction Robotic pancreaticoduodenectomy is slowly gaining acceptance within pancreatic surgery. Advantages have been demonstrated for robotic surgery in other fields, but robust data for pancreaticoduodenectomy is limited. The aim of this study was to compare the short-term outcomes of robotic pancreaticoduodenectomy (RPD) to open pancreaticoduodenectomy (OPD) and laparoscopic pancreaticoduodenectomy (LPD). Methods Patients who underwent a pancreaticoduodenectomy between January 2011 and July 2019 at the Johns Hopkins Hospital were included in this retrospective propensity-matched analysis. The RPD cohort was matched to patients who underwent OPD in a 1:2 fashion and LPD in a 1:1 fashion. Short-term outcomes were analyzed for all three cohorts. Results In total, 1644 patients were included, of which 96 (5.8%) underwent RPD, 131 (8.0%) LPD, and 1417 (86.2%) OPD. RPD was associated with a decreased incidence of delayed gastric emptying (9.4%) compared to OPD (23.5%; P = 0.006). The median estimated blood loss was significantly less in the RPD cohort (RPD vs OPD, 150 vs 487 mL; P < 0.001, RPD vs LPD, 125 vs 300 mL; P < 0.001). Compared to OPD, the robotic approach was associated with a shorter median length of stay (median 8 vs 9 days; P = 0.014) and a decrease in wound complications (4.2% vs 16.7%; P = 0.002). The incidence of other postoperative complications was comparable between RPD and OPD, and RPD and LPD. Conclusion In the hands of experienced surgeons, RPD may have a modest yet statistically significant reduction in estimated blood loss, postoperative length of stay, wound complications, and delayed gastric emptying comparing to OPD in similar patients. Keywords Robotic pancreaticoduodenectomy . Minimally invasive . Complications . Short-term outcomes . Laparoscopic
Introduction Pancreaticoduodenectomy (PD), often known as the Whipple procedure, is a complex operation accompanied by significant morbidity, with complication rates in the 30–40% range.1,2 A. Floortje van Oosten and Ding Ding contributed equally to this work. * Jin He [email protected] 1
Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD 21287, USA
2
Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
The procedure is characterized by an extensive dissection, identification of critical vascular anatomy, and technicall
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