Abstract
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.
Similar content being viewed by others
References
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, Kooby DA (2016) A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Ann Surg 264(640):649. https://doi.org/10.1097/sla.0000000000001869
Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M III (2013) 250 robotic pancreatic resections. Ann Surg 258(1):19. https://doi.org/10.1097/sla.0b013e3182a4e87c
Kowalsky SJ, Zenati MS, Steve J, Esper SA, Lee KK, Hogg ME, Zeh HJ, Zureikat AH (2018) A combination of robotic approach and ERAS pathway optimizes outcomes and cost for pancreatoduodenectomy. Ann Surg. https://doi.org/10.1097/sla.0000000000002707
McMillan MT, Zureikat AH, Hogg ME, Kowalsky SJ, Zeh HJ, Sprys MH, Vollmer CM (2017) A propensity score-matched analysis of robotic vs open pancreatoduodenectomy on incidence of pancreatic fistula. Jama Surg 152(327):335. https://doi.org/10.1001/jamasurg.2016.4755
Girgis MD, Zenati MS, Steve J, Bartlett DL, Zureikat A, Zeh HJ, Hogg ME (2017) Robotic approach mitigates perioperative morbidity in obese patients following pancreaticoduodenectomy. Hpb 19(1):6. https://doi.org/10.1016/j.hpb.2016.11.008
Girgis MD, Zenati MS, King JC, Hamad A, Zureikat AH, Zeh HJ, Hogg ME (2019) Oncologic outcomes after robotic pancreatic resections are not inferior to open surgery. Ann Surg. https://doi.org/10.1097/sla.0000000000003615
Cai J, Ramanathan R, Zenati MS, Abbas AA, Hogg ME, Zeh HJ, Zureikat AH (2019) Robotic pancreaticoduodenectomy is associated with decreased clinically relevant pancreatic fistulas: a propensity-matched analysis. J Gastrointest Surg. https://doi.org/10.1007/s11605-019-04274-1
Knab LM, Zenati MS, Khodakov A, Rice M, Al-abbas A, Bartlett DL, Zureikat AH, Zeh HJ, Hogg ME (2018) Evolution of a novel robotic training curriculum in a complex general surgical oncology fellowship. Ann Surg Oncol 25:3445–3452. https://doi.org/10.1245/s10434-018-6686-0
Magge D, Zenati M, Lutfi W, Hamad A, Zureikat AH, Zeh HJ, Hogg ME (2018) Robotic pancreatoduodenectomy at an experienced institution is not associated with an increased risk of post-pancreatic hemorrhage. Hpb 20:448–455. https://doi.org/10.1016/j.hpb.2017.11.005
Wang M, Cai H, Meng L, Cai Y, Wang X, Li Y, Peng B (2016) Minimally invasive pancreaticoduodenectomy: a comprehensive review. Int J Surg 35:139–146. https://doi.org/10.1016/j.ijsu.2016.09.016
Nassour I, Choti MA, Porembka MR, Yopp AC, Wang SC, Polanco PM (2018) Robotic-assisted versus laparoscopic pancreaticoduodenectomy: oncological outcomes. Surg Endosc 32(2907):2913. https://doi.org/10.1007/s00464-017-6002-2
Nassour I, Wang SC, Christie A, Augustine MM, Porembka MR, Yopp AC, Choti MA, Mansour JC, Xie X-J, Polanco PM, Minter RM (2017) Minimally invasive versus open pancreaticoduodenectomy: a propensity-matched study from a national cohort of patients. Ann Surg 268:1. https://doi.org/10.1097/sla.0000000000002259
Nassour I, Wang SC, Porembka MR, Yopp AC, Choti MA, Augustine MM, Polanco PM, Mansour JC, Minter RM (2017) Robotic versus laparoscopic pancreaticoduodenectomy: a NSQIP analysis. J Gastrointest Surg 244(10):9. https://doi.org/10.1007/s11605-017-3543-6
Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer DGI, Roman SA, Sosa JA (2015) Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg 262(372):377. https://doi.org/10.1097/sla.0000000000001055
Nota CLMA, Hagendoorn J, Rinkes IHMB, Harst E van der, Riele WWT, Santvoort HC van, Tran T, Coene PLO, Koerkamp BG, Molenaar IQ (2019) Robot-assisted Whipple resection; results of the first 100 procedures in the Netherlands. Ned Tijdschr Genees 163
He S, Ding D, Wright MJ, Groshek L, Javed AA, Chu KK-W, Burkhart RA, Cameron JL, Weiss MJ, Wolfgang CL, He J (2019) The impact of high body mass index on patients undergoing robotic pancreatectomy: a propensity matched analysis. Surgery 167:556–559. https://doi.org/10.1016/j.surg.2019.11.002
Giulianotti PC, Mangano A, Bustos RE, Fernandes E, Masrur MA, Valle V, Gangemi A, Bianco FM (2020) Educational step-by-step surgical video about operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique—lessons learned since the first worldwide RPD performed in the year 2001. Surg Endosc. https://doi.org/10.1007/s00464-020-07383-0
Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, D’Angelica MI, Balduzzi A, Bassi C, Björnsson B, Boggi U, Callery MP, Chiaro MD, Coimbra FJ, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil BH, Edwin B, Giulianotti PC, Han H-S, Hansen PD, van der Heijde N, van Hilst J, Hester CA, Hogg ME, Jarufe N, Jeyarajah DR, Keck T, Kim SC, Khatkov IE, Kokudo N, Kooby DA, Korrel M, de Leon FJ, Lluis N, Lof S, Machado MA, Demartines N, Martinie JB, Merchant NB, Molenaar IQ, Moravek C, Mou Y-P, Nakamura M, Nealon WH, Palanivelu C, Pessaux P, Pitt HA, Polanco PM, Primrose JN, Rawashdeh A, Sanford DE, Senthilnathan P, Shrikhande SV, Stauffer JA, Takaori K, Talamonti MS, Tang CN, Vollmer CM, Wakabayashi G, Walsh RM, Wang S-E, Zinner MJ, Wolfgang CL, Zureikat AH, Zwart MJ, Conlon KC, Kendrick ML, Zeh HJ, Hilal MA, Besselink MG (2019) The miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg. https://doi.org/10.1097/sla.0000000000003590
Dhir M, Zenati MS, Hamad A, Singhi AD, Bahary N, Hogg ME, Zeh HJ, Zureikat AH (2018) FOLFIRINOX versus gemcitabine/nab-paclitaxel for neoadjuvant treatment of resectable and borderline resectable pancreatic head adenocarcinoma. Ann Surg Oncol 25:1896–1903. https://doi.org/10.1245/s10434-018-6512-8
Janssen QP, Buettner S, Suker M, Beumer BR, Addeo P, Bachellier P, Bahary N, Bekaii-Saab T, Bali MA, Besselink MG, Boone BA, Chau I, Clarke S, Dillhoff M, El-Rayes BF, Frakes JM, Grose D, Hosein PJ, Jamieson NB, Javed AA, Khan K, Kim K-P, Kim SC, Kim SS, Ko AH, Lacy J, Margonis GA, McCarter MD, McKay CJ, Mellon EA, Moorcraft SY, Okada K-I, Paniccia A, Parikh PJ, Peters NA, Rabl H, Samra J, Tinchon C, van Tienhoven G, van Veldhuisen E, Wang-Gillam A, Weiss MJ, Wilmink JW, Yamaue H, Homs MYV, van Eijck CHJ, Katz MHG, Koerkamp BG (2019) Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer: a systematic review and patient-level meta-analysis. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djz073
Reames BN, Blair AB, Krell RW, Groot VP, Gemenetzis G, Padussis JC, Thayer SP, Falconi M, Wolfgang CL, Weiss MJ, Are C, He J (2019) Management of locally advanced pancreatic cancer. Ann Surg. https://doi.org/10.1097/sla.0000000000003568
Peng L, Lin S, Li Y, Xiao W (2017) Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy. Surg Endosc 31:3085–3097. https://doi.org/10.1007/s00464-016-5371-2
Croome KP, Farnell MB, Que FG, Km R-L, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260(633):640. https://doi.org/10.1097/sla.0000000000000937
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Ibrahim Nassour MD MSCS, Samer Tohme MD, Richard Hoehn MD, Mohamed Abdelgadir Adam MD, Amer H Zureikat MD, and Paniccia Alessandro MD have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Nassour, I., Tohme, S., Hoehn, R. et al. Safety and oncologic efficacy of robotic compared to open pancreaticoduodenectomy after neoadjuvant chemotherapy for pancreatic cancer. Surg Endosc 35, 2248–2254 (2021). https://doi.org/10.1007/s00464-020-07638-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07638-w