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Short- and long-term outcomes of robotic versus open radical antegrade modular pancreatosplenectomy: a retrospective propensity score-matched cohort study

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Abstract

Background

Robotic distal pancreatectomy has increasingly been accepted as it has overcome some of the limitations of open distal pancreatectomy, whilst the outcomes following robotic radical antegrade modular pancreatosplenectomy (RAMPS) in patients with pancreatic ductal adenocarcinoma (PDAC) are still uncertain. This study aimed to evaluate the short and long-term outcomes of robotic RAMPS and open RAMPS for PDAC.

Methods

The patients who underwent robotic RAMPS and open RAMPS for PDAC at our clinical centre between January 2017 and December 2021 were reviewed. After a propensity score matching (PSM) at a 1:1 ratio, the perioperative and pathological outcomes in the both groups were reviewed. Univariable and multivariable Cox regression analyses were used to identify independent prognosis factors for overall survival (OS) and recurrence-free survival (RFS) of these patients.

Results

318 cases were recorded in robotic and open groups. The robotic group showed advantages in operative time [205.00 (166.00, 240.00) min vs 235 (184.75, 270.00) min, P = 0.002], estimated blood loss [100 (50, 100) ml vs 300 (100, 400) ml, P < 0.001], delayed gastric emptying [0 vs 5.03%, P = 0.007] and postoperative hospital stay [7.00 (5.00, 10.00) days vs 11.00 (8.00, 14.00) days, P < 0.001]. There were no significant differences in rate of severe postoperative complications between the robotic group and the open group. Multivariable analysis showed that carbohydrate antigen 19-9, estimated blood loss, N stage, tumour differentiation, chemotherapy and vascular invasion were independent risk factors for OS and RFS of these patients.

Conclusions

Robotic RAMPS was safe and had some advantages over open RAMPS for PDAC. There were no significantly differences in oncological outcomes and long-term survival rates between the robotic and open groups. Robotic RAMPS expanded the indications for minimally invasive surgeries for PDAC to a certain extent.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

RAMPS:

Radical antegrade modular pancreatosplenectomy

PDAC:

Pancreatic ductal adenocarcinoma

PSM:

Propensity score matching

OS:

Overall survival

RFS:

Recurrence-free survival

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

AJCC:

American Joint Committee on Cancer

S.D:

Standard deviation

IQR:

Interquartile range

HR:

Hazard ratio

CI:

Confidence interval

CR-POPF:

Clinically relevant postoperative fistulas

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Acknowledgements

This study was not supported by any funding.

Author information

Author notes

  1. Yuyao Song, Wenbo Zou, and Yuanxing Gao have contributed equally to this study.

Authors and Affiliations

  1. The Faculty of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Yuyao Song, Wenbo Zou, Yuanxing Gao, Zhiming Zhao, Zhuzeng Yin, Chaohui Xiao & Rong Liu

  2. Department of General Surgery, No. 924 Hospital of PLA Joint Logistic Support Force, Guilin, China

    Wenbo Zou

  3. Organ Transplantation Department, The Third Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China

    Qu Liu

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  1. Yuyao Song
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Contributions

Conception and design: RL, YS, WZ, YG; Provision of study materials or patients: ZZ, ZY, CX; Collection and assembly of data: YS, WZ, YG, QL; Data analysis and interpretation: YS, WZ, QL; Manuscript writing: YS, WZ, YG; Final approval of manuscript: All authors.

Corresponding author

Correspondence to Rong Liu.

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Disclosures

Yuyao Song, Wenbo Zou, Yuanxing Gao, Zhiming Zhao, Zhuzeng Yin, Chaohui Xiao, Qu Liu and Rong Liu have no conflicts of interest or financial ties to disclose.

Consent to participate

Written informed consent was obtained from all patients.

Ethical approval

This study was approved by the Institutional Review Board at the First Medical Center, Chinese People’s Liberation Army General Hospital (S2020-252-14).

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Song, Y., Zou, W., Gao, Y. et al. Short- and long-term outcomes of robotic versus open radical antegrade modular pancreatosplenectomy: a retrospective propensity score-matched cohort study. Surg Endosc 38, 1316–1328 (2024). https://doi.org/10.1007/s00464-023-10635-4

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  • DOI: https://doi.org/10.1007/s00464-023-10635-4

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