Short-term Outcomes After Robot-Assisted vs Open Pancreaticoduodenectomy After the Learning Curve

This cohort study assesses robot-assisted vs open pancreaticoduodenectomy after the learning curve. Key PointsQuestionWhat are the actual advantages of robot-assisted pancreaticoduodenectomy (PD) after the learning curve? FindingsIn this cohort study of 187 individuals, robot-assisted PD had advantages over open PD in operative time, estimated blood loss, and postoperative hospital stay after the learning curve. MeaningThe true advantages of robot-assisted PD could be revealed after passing the learning curve. ImportanceRobot-assisted pancreaticoduodenectomy (RPD) has been reported to be safe and feasible. As a new technique, RPD has a learning curve similar to that of other types of minimally invasive pancreatic surgery such as laparoscopic pancreaticoduodenectomy. To our knowledge, no reports exist on the outcomes of open pancreaticoduodenectomy (OPD) and RPD after the learning curve. ObjectiveTo analyze and evaluate the actual advantages of RPD. Design, Setting, and ParticipantsBetween May 2010 and December 2018, 450 patients underwent RPD in the Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University in Shanghai, China, a high-volume pancreatic disease center. According to our previous study, an important flexion point in the learning curve is 250 cases. Data on the last 200 RPD cases were collected from January 2017 to December 2018. During that period, 634 patients underwent OPD. These patients were divided into 2 groups, and propensity score matching was used to minimize bias. The demographic data and operative outcomes were collected and analyzed. Analysis began May 2019. ExposuresRobot-assisted pancreaticoduodenectomy and OPD. Main Outcomes and MeasuresThe short-term operative outcomes of RPD and OPD. ResultsAfter 1:1 matching, 187 cases of RPD and OPD were recorded. In the RPD group, 78 patients (41.7%) were women, and the mean (SD) age was 60.9(11.4) years. In the OPD group, 80 patients (42.8%) were women, and the mean (SD) age was 60.1(10.8) years. Robot-assisted pancreaticoduodenectomy had advantages in operative time (mean [SD], 279.7[76.3] minutes vs 298.2[78.3] minutes; P=.02), estimated blood loss (mean [SD], 297.3[246.8] mL vs 415.2[497.9] mL; P=.002), and postoperative length of hospital stay (mean [SD], 22.4[16.7] days vs 26.1[16.3] days; P=.03). However, there was no significant difference in the R0 resection rate and incidence rate of postoperative complications, such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. The incidence rates of postoperative bleeding and reoperation in the RPD group were similar to those in the OPD group, with no statistically significant difference. Conclusions and RelevanceAfter passing the learning curve, RPD had advantages in operative time and blood loss compared with OPD. There were no differences in postoperative complications such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. However, patients recovered more quickly after RPD than after OPD. A prospective randomized clinical trial is needed in the future to verify these results.