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Robotic-assisted versus laparoscopic pancreaticoduodenectomy: oncological outcomes

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Abstract

Background

Minimally invasive pancreaticoduodenectomy (MIPD) is being performed with increasing frequency for pancreatic cancer, but the most oncologically efficacious surgical platform, whether robotic or laparoscopic, is yet to be determined. Currently, there are no national studies comparing the oncological outcomes between robotic (RPD) and laparoscopic (LPD) pancreaticoduodenectomy.

Methods

This was a retrospective study using the National Cancer Database between 2010 and 2013. We compared the perioperative, pathological, and mid-term oncological outcomes between RPD and LPD.

Results

There were 1623 MIPD cases, of which 90% were LPD and 10% were RPD. Most LPD (63%) and RPD (51%) cases were performed at institutions with a volume of ≤ 5 MIPDs per year. There were no differences in patient- and tumor-related factors between the groups. The majority of treated tumors were adenocarcinoma (90.1% for RPD and 89.1% for LPD). RPDs were more likely to be performed at academic centers (89.1%) compared to LPDs (68.1%, P < 0.001) and at higher-volume centers (median MIPD/year of 4.7 for RPD vs 3.6 for LPD, P < 0.001). There was no difference in the median number of examined lymph nodes, margin status, median length of stay, 90-day mortality, or 30-day readmission between groups. There was no difference in median overall survival for pancreatic adenocarcinoma between LPD (20.7 months) and RPD (22.7 months; log-rank P = 0.445). The 1- and 3-year overall survival rates were 74 and 31% for LPD and 71 and 33% for RPD.

Conclusion

In this national cohort of patients, LPD and RPD were associated with equivalent perioperative, pathological, and mid-term oncological outcomes.

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Acknowledgements

The authors would like to thank Dave Primm for his help in editing this manuscript and Helen Mayo from the UTSW Health Sciences Digital Library and Learning Center for assistance with literature searches.

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8548, USA

    Ibrahim Nassour, Michael A. Choti, Matthew R. Porembka, Adam C. Yopp, Sam C. Wang & Patricio M. Polanco

  2. Department of Veterans Affairs North Texas Health Care System, Dallas, TX, USA

    Patricio M. Polanco

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  1. Ibrahim Nassour
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  2. Michael A. Choti
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Correspondence to Patricio M. Polanco.

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Disclosures

Ibrahim Nassour, Michael A. Choti, Matthew R. Porembka, Adam C. Yopp, Sam C.Wang, and Patricio M. Polanco have no other conflicts of interest or financial ties to disclose.

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Nassour, I., Choti, M.A., Porembka, M.R. et al. Robotic-assisted versus laparoscopic pancreaticoduodenectomy: oncological outcomes. Surg Endosc 32, 2907–2913 (2018). https://doi.org/10.1007/s00464-017-6002-2

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  • DOI: https://doi.org/10.1007/s00464-017-6002-2

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