Oncological outcomes of robotic-assisted versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score-matched analysis

Background Robotic-assisted minimally invasive surgery is associated with worse oncologic outcomes for some but not other types of cancers. We conducted a propensity score-matched analysis to compare oncologic outcomes of robotic-assisted laparoscopic (RPD)vs.open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). Methods Treatment-naive PDAC patients undergoing either RPD or OPD at our hospital between January 2013 and December 2017 were included. Propensity score matching was conducted at a ratio of 1:2. The primary outcome was disease-free survival (DFS) and overall survival (OS). Results A total of 672 cases were identified. The propensity score-matched cohort included 105 patients receiving RPD and 210 patients receiving OPD. The 2 groups did not differ in the number of retrieved lymph nodes [11 (7-16)vs.11 (6-17),P = 0.622] and R0 resection rate (88.6%vs. 89.0%,P = 0.899). There was no statistically significant difference in median DFS (14 [95% CI 11-22]vs.12 [95% CI 10-14] months (HR 0.94; 95% CI 0.87-1.50; log-rankP = 0.345) and median OS (27 [95% CI 22-35]vs.20 [95% CI 18-24] months (HR 0.77; 95% CI 0.57-1.04; log-rankP = 0.087) between the two groups. Multivariate COX analysis showed that RPD was not an independent predictor of DFS (HR 0.90; 95% CI 0.68-1.19,P = 0.456) or OS (HR 0.77; 95% CI 0.57-1.05,P = 0.094). Conclusion Comparable DFS and OS were observed between patients receiving RPD and OPD. This preliminary finding requires further confirmation with prospective randomized controlled trials.

Automated summary

Robot-assisted minimally invasive surgery for PDAC showed comparable disease-free survival and overall survival outcomes to open surgery in a propensity score-matched analysis. Further confirmation through prospective randomized controlled trials is needed.