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Robotic versus open pancreaticoduodenectomy with vascular resection for pancreatic ductal adenocarcinoma: surgical and oncological outcomes from pilot experience

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Abstract

Purpose

Venous resection and reconstruction (VR) is a feasible surgical technique to achieve optimal outcomes in selected patients with pancreatic ductal adenocarcinoma (PDAC) who undergo open pancreaticoduodenectomy (OPD). However, data regarding patient outcomes in patients who undergo VR in robotic-assisted pancreaticoduodenectomy (RPD) are scarce.

Methods

All patients with a diagnosis of PDAC who underwent upfront open or robotic pancreatoduodenectomy with VR in a high-volume institution for pancreatic surgery between 2011 and 2019 were retrospectively reviewed. Perioperative and long-term outcomes were compared between the RPD and OPD cohorts.

Results

A total of 84 patients were included in the final analysis, 14 patients underwent RPD with VR and 70 who had OPD with VR. Reconstructed venous patency, postoperative 30-day morbidity, and 90-day mortality were comparable; however, lymph node resection rates were lower in the RPC cohort (p = 0.029). No difference was identified in 3-year survival rates between the two groups (34.0% versus 25.7% respectively, p = 0.667).

Conclusion

RPD with VR is a feasible approach for patients with PDAC and venous invasion. Further studies are needed to assess long-term outcomes compared to the open approach.

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Data availability

The authors are responsible for the data described in the manuscript and assure full availability of the study material.

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Acknowledgements

The authors would like to thank all the participating patients and their families as well as the investigators, research nurses, study coordinators, and operation staff.

Funding

This study is sponsored by the Guangci Outstanding Youth Training Program (GCQN-2017-B06) and the Interdisciplinary Program of Shanghai Jiao Tong University (YG2019QNB26).

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Authors and Affiliations

  1. Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Jiabin Jin, Yuanchi Weng, Mengmin Chen, Yusheng Shi, Xiayang Ying, Kai Qin, Jun Zhang, Xiaxing Deng, Chenghong Peng & Baiyong Shen

  2. Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Jiabin Jin, Yuanchi Weng, Mengmin Chen, Yusheng Shi, Xiayang Ying, Kai Qin, Jun Zhang, Xiaxing Deng, Chenghong Peng & Baiyong Shen

  3. Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Shih-min Yin

  4. HPB Unit, Royal Infirmary Edinburgh, Edinburgh, UK

    Georgios Gemenetzis

  5. Department of Pancreatic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Xiaxing Deng, Chenghong Peng & Baiyong Shen

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  1. Jiabin Jin
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  2. Shih-min Yin
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  4. Mengmin Chen
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  8. Kai Qin
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  10. Xiaxing Deng
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  12. Baiyong Shen
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Contributions

Jiabin Jin MD, Shih-min Yin, and Yuanchi Weng conceived and designed the study. Mengmin Chen, Yusheng Shi, and Xiayang Ying made substantial contribution to data collection and analysis; Jiabin Jin MD, Shih-min Yin, Georgios Gemenetzis, and Yuanchi Weng participated in drafting the article; Georgios Gemenetzis, Xiaxing Deng, Chenghong Peng, and Baiyong Shen revised the manuscript critically for important intellectual contents. Jiabin Jin, Shih-min Yin, and Yuanchi Weng contributed equally to this work and should be considered co-first authors. Xiaxing Deng, Chenghong Peng, and Baiyong Shen also contributed equally and should be considered co-corresponding authors.

Corresponding authors

Correspondence to Xiaxing Deng, Chenghong Peng or Baiyong Shen.

Ethics declarations

Research involving human participants and/or animals

The study was approved by the Ruijin Clinical Trial Ethics Committee, under authorization 2017–180, and was conducted at Shanghai JiaoTong University School of Medicine.

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Not applicable.

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The authors declare no competing interests.

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Headings

1. Robotic pancreaticoduodenectomy with vascular resection is a feasible for patients with pancreatic cancer.

2. Robotic pancreaticoduodenectomy with vascular resection had similar oncological and survival outcome compared to an open method.

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Jin, J., Yin, Sm., Weng, Y. et al. Robotic versus open pancreaticoduodenectomy with vascular resection for pancreatic ductal adenocarcinoma: surgical and oncological outcomes from pilot experience. Langenbecks Arch Surg 407, 1489–1497 (2022). https://doi.org/10.1007/s00423-021-02364-w

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