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Propensity score-matched comparison of the oncological feasibility and survival outcomes for pancreatic adenocarcinoma with robotic and open pancreatoduodenectomy

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Abstract

Background

This study is to clarify the feasibility of and justification for robotic pancreaticoduodenectomy (RPD) in patients with pancreatic adenocarcinoma.

Methods

A 1-to-1 propensity score-matched comparison of RPD and open pancreaticoduodenectomy (OPD) was performed based on six covariates commonly used to predict the survival outcome for pancreatic adenocarcinoma.

Results

A total of 130 patients were enrolled, with 65 in each study group after propensity score matching. The median operating time was longer for RPD (8.3 h vs. 7.0 h, P = 0.002). However, RPD was associated with less blood loss, lower overall surgical complication rate, and lower incidence of delayed gastric emptying. The resection radicality was oncologically similar between these two groups, but the median lymph node yield was higher for RPD (18 vs. 16, P = 0.038). Before propensity score matching, the 5-year survival was better in RPD (27.0% vs. 17.6%, P = 0.006). After matching, there was still a trend towards improved overall survival in the RPD group; however, the difference in 5-year survival between RPD and OPD was not significant (24.5% vs. 19.7%, P = 0.088).

Conclusion

RPD is not only technically feasible with no increase in surgical risk but also oncologically justifiable without compromising survival outcome. However, unlike randomized control trials, the limitations in this propensity score-matched analysis only accounted for 6 observed covariates commonly used to predict the survival outcome in patients with pancreatic adenocarcinoma, and confounders not included in this study could also affect our results.

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References

  1. Jang JY, Kang MJ, Heo JS, Choi SH, Choi DW, Park SJ, Han SS, Yoon DS, Yu HC, Kang KJ, Kim SG, Kim SW (2014) A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer. Ann Surg 259(4):656–664

    Article  Google Scholar 

  2. Inoue Y, Saiura A, Yoshioka R, Ono Y, Takahashi M, Arita J, Takahashi Y, Koga R (2015) Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg 262(6):1092–1101

    Article  Google Scholar 

  3. McMillan MT, Zureikat AH, Hogg ME, Kowalsky SJ, Zeh HJ, Sprys MH, Vollmer CM Jr (2017) A propensity score-matched analysis of robotic vs open pancreatoduodenectomy on incidence of pancreatic fistula. JAMA Surg 152(4):327–335

    Article  Google Scholar 

  4. Napoli N, Kauffmann EF, Menonna F, Costa F, Iacopi S, Amorese G, Giorgi S, Baggiani A, Boggi U (2018) Robotic versus open pancreatoduodenectomy: a propensity score-matched analysis based on factors predictive of postoperative pancreatic fistula. Surg Endosc 32(3):1234–1247

    Article  Google Scholar 

  5. Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8(5):408–410

    Article  CAS  Google Scholar 

  6. Boggi U, Signori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, Amorese G, Mosca F (2013) Feasibility of robotic pancreaticoduodenectomy. Br J Surg 100(7):917–925

    Article  CAS  Google Scholar 

  7. Wang SE, Shyr BU, Chen SC, Shyr YM (2018) Comparison between robotic and open pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: a propensity score-matched study. Surgery 164(6):1162–1167

    Article  Google Scholar 

  8. Beane JD, Zenati M, Hamad A, Hogg ME, Zeh HJ 3rd, Zureikat AH (2019) Robotic pancreatoduodenectomy with vascular resection: outcomes and learning curve. Surgery 166(1):8–14

    Article  Google Scholar 

  9. Zhang YH, Zhang CW, Hu ZM, Hong DF (2016) Pancreatic cancer: open or minimally invasive surgery? World J Gastroenterol 22(32):7301–7310

    Article  CAS  Google Scholar 

  10. Wang SE, Chen SC, Shyr BU, Shyr YM (2016) Comparison of Modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. HPB 18(3):229–235

    Article  Google Scholar 

  11. Shyr BU, Chen SC, Shyr YM, Wang SE (2020) Surgical, survival, and oncological outcomes after vascular resection in robotic and open pancreaticoduodenectomy. Surg Endosc 34(1):377–383

    Article  Google Scholar 

  12. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Chiaro MD, Falconi M, Fernandez-Cruz K, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591

    Article  Google Scholar 

  13. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768

    Article  Google Scholar 

  14. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25

    Article  Google Scholar 

  15. Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Buchler MW, Busch OR, Charnley RM, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Izbicki KD, Lillemoe JR, Neoptolemos JP, Sarr MG, Shrikhande R, Sitarz SV, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ (2017) Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 161(2):365–372

    Article  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  Google Scholar 

  17. Evans DB, Farnell MB, Lillemoe KD, Vollmer C Jr, Strasberg SM, Schulick RD (2009) Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 16(7):1736–1744

    Article  Google Scholar 

  18. Gagner M, Palermo M (2009) Laparoscopic Whipple procedure: review of the literature. J Hepatobiliary Pancreat Surg 16(6):726–730

    Article  Google Scholar 

  19. Boggi U, Amorese G, Vistoli F, Caniglia F, De Lio N, Perrone V, Barbarello L, Belluomini M, Signori S, Mosca F (2015) Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc 29(1):9–23

    Article  Google Scholar 

  20. Nassour I, Tohme S, Hoehn R, Adam MA, Zureikat AH, Alessandro P (2020) Safety and oncologic efficacy of robotic compared to open pancreaticoduodenectomy after neoadjuvant chemotherapy for pancreatic cancer. Surg Endosc. https://doi.org/10.1007/s00464-020-07638-w

    Article  PubMed  Google Scholar 

  21. Kauffmann EF, Napoli N, Menonna F, Iacopi S, Lombardo C, Bernardini J, Amorese G, Cacciato Insilla A, Funel N, Campani D, Cappelli C, Caramella D, Boggi U (2019) A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status. Surg Endosc 33(1):234–242

    Article  Google Scholar 

  22. Polanco PM, Zenati MS, Hogg ME, Shakir M, Boone BA, Bartlett DL, Zeh HJ, Zureikat AH (2016) An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions. Surg Endosc 30(4):1523–1529

    Article  Google Scholar 

  23. Napoli N, Kauffmann EF, Menonna F, Perrone VG, Brozzetti S, Boggi U (2016) Indications, technique, and results of robotic pancreatoduodenectomy. Updates Surg 68(3):295–305

    Article  Google Scholar 

  24. Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 58(4):554–559 (discussion 559-562)

    Article  Google Scholar 

  25. Zureikat AH, Postlewait LM, Liu Y, Gillespie TW, Weber SM, Abbott DE, Ahmad SA, Maithel SK, Hogg ME, Zenati M, Cho CS, Salem A, Xia B, Steve J, Nguyen TK, Keshava HB, Chalikonda S, Walsh RM, Talamonti MS, Stocker SJ, Bentrem DJ, Lumpkin S, Kim HJ, Zeh HJ 3rd, Kooby DA (2016) A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Ann Surg 264(4):640–649

    Article  Google Scholar 

  26. Peng L, Lin S, Li Y, Xiao W (2017) Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy. Surg Endosc 31(8):3085–3097

    Article  Google Scholar 

  27. Esposito A, Balduzzi A, De Pastena M, Fontana M, Casetti L, Ramera M, Bassi C, Salvia R (2019) Minimally invasive surgery for pancreatic cancer. Expert Rev Anticancer Ther 19(11):947–958

    Article  CAS  Google Scholar 

  28. Baimas-George M, Watson M, Murphy KJ, Iannitti D, Baker E, Ocuin L, Vrochides D, Martinie JB (2020) Robotic pancreaticoduodenectomy may offer improved oncologic outcomes over open surgery: a propensity-matched single-institution study. Surg Endosc 34(8):3644–3649

    Article  Google Scholar 

  29. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the support of the Biobank of Taipei Veterans General Hospital. This work was financially supported by grants from the Taipei Veterans General Hospital (V110B-023, V110C-010 and V110C-011), the Ministry of Science and Technology (MOST 108-2314-B-075-051-MY3), and the Ministry of Health and Welfare (MOHW107-TDU-B-212-114026A).

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, 201 Section 2 Shipai Road, Taipei, 112, Taiwan

    Bor-Uei Shyr, Bor-Shiuan Shyr, Shih-Chin Chen, Yi-Ming Shyr & Shin-E Wang

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Correspondence to Shin-E Wang.

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Dr. Bor-Uei Shyr, Bor-Shiuan Shyr, Shih-Chin Chen, Yi-Ming Shyr, and Shin-E Wang have no conflicts of interest or financial ties to disclose.

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Shyr, BU., Shyr, BS., Chen, SC. et al. Propensity score-matched comparison of the oncological feasibility and survival outcomes for pancreatic adenocarcinoma with robotic and open pancreatoduodenectomy. Surg Endosc 36, 1507–1514 (2022). https://doi.org/10.1007/s00464-021-08437-7

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