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Erschienen in:
21.05.2020
Safety and oncologic efficacy of robotic compared to open pancreaticoduodenectomy after neoadjuvant chemotherapy for pancreatic cancer
Erschienen in: Surgical Endoscopy | Ausgabe 5/2021
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Background
Emerging data from multi-institutional and national databases suggest that robotic pancreaticoduodenectomy is safe and feasible for pancreatic adenocarcinoma. Nevertheless, there are limited reports evaluating its safety and oncologic efficacy following neoadjuvant chemotherapy.
Method
This is a retrospective study from the 2010–2016 National Cancer Database comparing the postoperative, pathological and long-term oncologic outcomes between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) for pancreatic adenocarcinoma following neoadjuvant chemotherapy.
Results
We identified 155 (5%) RPD and 3329 (95%) OPD following neoadjuvant chemotherapy. The use of the robot increased from 3 cases in 2010 to 50 cases in 2016. RPD patients were more likely to receive adjuvant chemotherapy and to be treated at academic centers. After adjustment, RPD was associated with a higher proportion of adequate lymphadenectomy, receipt of adjuvant chemotherapy, decreased rate of prolonged length of stay, and similar 90-day mortality. There was no difference in median overall survival between RPD and OPD (25.6 months vs. 27.5 months, Log Rank p = 0.879). The 1-, 3- and 5-year overall survival rates for RPD were 83%, 36% and 22% and for OPD were 86%, 38% and 22%. After adjustment, the use of robotic surgery was associated with similar overall survival compared to the open approach (HR 1.011, 95% confidence interval (CI) 0.776–1.316).
Conclusions
Following neoadjuvant chemotherapy, RPD is associated with similar short- and long-term mortality with the advantage of shorter length of stay, higher proportion of adequate lymphadenectomy and receipt of adjuvant chemotherapy.