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A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status

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Abstract

Background

No study has shown the oncologic non-inferiority of robotic pancreatoduodenectomy (RPD) versus open pancreatoduodenectomy (OPD) for pancreatic cancer (PC).

Methods

This is a single institution propensity score matched study comparing RPD and ODP for resectable PC, based on factors predictive of R1 resection (≤ 1 mm). Only patients operated on after completion of the learning curve in both procedures and for whom circumferential margins were assessed according to the Leeds pathology protocol were included. The primary study endpoint was the rate of R1 resection. Secondary study endpoints were as follows: number of examined lymph nodes (N), rate of perioperative transfusions, percentage of patients receiving adjuvant therapies, occurrence of local recurrence, overall survival, disease-free survival, and sample size calculation for randomized controlled trials (RCT).

Results

Factors associated with R1 resection were tumor diameter, number of positive N, N ratio, logarithm odds of positive N, and duodenal infiltration. The matching process identified 20 RPDs and 24 OPDs. All RPDs were completed robotically. R1 resection was identified in 11 RPDs (55.0%) and in 10 OPDs (41.7%) (p = 0.38). There was no difference in the rate of R1 at each margin as well as in the proportion of patients with multiple R1 margins. RPD and OPD were also equivalent with respect to all secondary study endpoints, with a trend towards lower rate of blood transfusions in RPD. Based on the figures presented herein, a non-inferiority RCT comparing RPD and OPD having the rate of R1 resection as the primary study endpoint requires 3355 pairs.

Conclusions

RPD and OPD achieved the same rate of R1 resections in resectable PC. RPD was also non-inferior to OPD with respect to all secondary study endpoints. Because of the high number of patients required to run a RCT, further assessment of RPD for PC would require the implementation of an international registry.

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Authors and Affiliations

  1. Division of General and Transplant Surgery, University of Pisa, Pisa, Italy

    Emanuele F. Kauffmann, Niccolò Napoli, Francesca Menonna, Sara Iacopi, Carlo Lombardo, Juri Bernardini & Ugo Boggi

  2. Division of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy

    Gabriella Amorese

  3. Division of Pathology, University of Pisa, Pisa, Italy

    Andrea Cacciato Insilla, Niccola Funel & Daniela Campani

  4. Division of Radiology, University of Pisa, Pisa, Italy

    Carla Cappelli & Davide Caramella

  5. Azienda Ospedaliera Universitaria Pisana, Università di Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Ugo Boggi

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  1. Emanuele F. Kauffmann
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Corresponding author

Correspondence to Ugo Boggi.

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Disclosures

Emanuele F Kauffmann, Niccolò Napoli, Francesca Menonna, Sara Iacopi, Carlo Lombardo, Juri Bernardini, Gabriella Amorese, Andrea Cacciato Insilla, Niccola Funel, Daniela Campani, Carla Cappelli, Davide Caramella, and Ugo Boggi have no conflicts of interest or financial ties to disclose.

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Kauffmann, E.F., Napoli, N., Menonna, F. et al. A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status. Surg Endosc 33, 234–242 (2019). https://doi.org/10.1007/s00464-018-6301-2

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  • DOI: https://doi.org/10.1007/s00464-018-6301-2

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