A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy

Amer H. Zureikat, Lauren M. Postlewait, Yuan Liu, Theresa W. Gillespie, Sharon M. Weber, Daniel E. Abbott, Syed A. Ahmad, Shishir K. Maithel, Melissa E. Hogg, Mazen Zenati, Clifford S. Cho, Ahmed Salem, Brent Xia, Jennifer Steve, Trang K. Nguyen, Hari B. Keshava, Sricharan Chalikonda, R. Matthew Walsh, Mark S. Talamonti, Susan J. StockerDavid J. Bentrem, Stephanie Lumpkin, Hong J. Kim, Herbert J. Zeh, David A. Kooby

Research output: Contribution to journalArticle

86 Scopus citations

Abstract

Objectives: Limited data exist comparing robotic and open approaches to pancreaticoduodenectomy (PD). We performed a multicenter comparison of perioperative outcomes of robotic PD (RPD) and open PD (OPD). Methods: Perioperative data for patients who underwent postlearning curve PD at 8 centers (8/2011-1/2015) were assessed. Univariate analyses of clinicopathologic and treatment factors were performed, and multivariable models were constructed to determine associations of operative approach (RPD or OPD) with perioperative outcomes. Results: Of the 1028 patients, 211 (20.5%) underwent RPD (4.7% conversions) and 817 (79.5%) underwent OPD. As compared with OPD, RPD patients had higher body mass index, rates of prior abdominal surgery, and softer pancreatic remnants, whereas OPD patients had a higher percentage of pancreatic ductal adenocarcinoma cases, and greater proportion of nondilated (<3 mm) pancreatic ducts. On multivariable analysis, as compared with OPD, RPD was associated with longer operative times [mean difference = 75.4 minutes, 95% confidence interval (CI) 17.5-133.3, P = 0.01], reduced blood loss (mean difference=-181 mL, 95% CI -355-(-7.7), P = 0.04) and reductions in major complications (odds ratio = 0.64, 95% CI 0.47-0.85, P = 0.003). No associations were demonstrated between operative approach and 90-day mortality, clinically relevant postoperative pancreatic fistula and wound infection, length of stay, or 90-day readmission. In the subset of 522 (51%) pancreatic ductal adenocarcinomas, operative approach was not a significant independent predictor of margin status or suboptimal lymphadenectomy (<12 lymph nodes harvested). Conclusions: Postlearning curve RPD can be performed with similar perioperative outcomes achieved with OPD. Further studies of cost, quality of life, and long-term oncologic outcomes are needed.

Original languageEnglish (US)
Pages (from-to)640-649
Number of pages10
JournalAnnals of surgery
Volume264
Issue number4
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Keywords

  • Minimally invasive surgery
  • Outcomes
  • Pancreatectomy whipple
  • Pancreaticoduodenectomy
  • Robotic-assisted surgery

ASJC Scopus subject areas

  • Surgery

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    Zureikat, A. H., Postlewait, L. M., Liu, Y., Gillespie, T. W., Weber, S. M., Abbott, D. E., Ahmad, S. A., Maithel, S. K., Hogg, M. E., Zenati, M., Cho, C. S., Salem, A., Xia, B., Steve, J., Nguyen, T. K., Keshava, H. B., Chalikonda, S., Walsh, R. M., Talamonti, M. S., ... Kooby, D. A. (2016). A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Annals of surgery, 264(4), 640-649. https://doi.org/10.1097/SLA.0000000000001869