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Pancreaticoduodenectomy for benign and premalignant pancreatic and ampullary disease: is robotic surgery the better approach?

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Abstract

Background

The robotic platform is increasingly being utilized in pancreatic surgery, yet its overall merits and putative advantages remain to be adjudicated. We hypothesize that the benefits of minimally invasive pancreatic surgery are maximized in pancreatic benign and premalignant disease, in the setting of friable pancreatic tissue and small pancreatic duct.

Methods

Retrospective analysis of our prospectively maintained pancreatic database of all consecutive patients who underwent pancreaticoduodenectomy (PD) for benign or premalignant conditions between 2010 and 2020. Peri-operative outcomes and long-term complications were compared between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD).

Results

One hundred and eighty eight (n = 188) patients met our inclusion criteria, of which 68 were OPD and 120 RPD. Malignant histologies were excluded. There were only minor differences in baseline characteristics between the two groups. Post-operative merits of the RPD included lower clinically relevant post-operative pancreatic fistula 10 (8.3%) vs 24 (35.3%), p < 0.001, fewer surgical site infections; 9 (7.5%) vs 11 (16.2%), p = 0.024, shorter operative time, greater lymph node yield; 29 (IQR 21, 38) vs 21 (IQR 13, 34), p = 0.001, and lower 90 days mortality; 1 (0.8%) vs 4 (5.9%), p = 0.039. Rates of long-term complications were similar, exception made for a higher occurrence of small bowel obstruction (SBO) 2 (1.7%) vs 4 (5.9%), p = 0.031 and need for surgical intervention for SBO 0 (0.0%) vs 2 (2.9%), p = 0.019 in the OPD group.

Conclusion

Our study suggests that RPD benefits include lower 90-day mortality, shorter LOS, and lower rates of selected complications compared to open pancreaticoduodenectomy.

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Authors and Affiliations

  1. Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Scaife Hall, Suite A425, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Benedetto Mungo, Abdulrahman Hammad, Samer AlMasri, Epameinondas Dogeas, Kenneth K. W. Lee, Amer H. Zureikat & Alessandro Paniccia

  2. Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, FL, USA

    Ibrahim Nassour

  3. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Aatur D. Singhi

  4. Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Herbert J. Zeh III

  5. Department of Surgery, North Shore University, Chicago, IL, USA

    Melissa E. Hogg

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  1. Benedetto Mungo
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Correspondence to Alessandro Paniccia.

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Disclosures

Drs. Benedetto Mungo, Abdulrahman Hammad, Samer AlMasri, Epameinondas Dogeas, Ibrahim Nassour, Aatur D. Singhi, Herbert J. Zeh III, Melissa E. Hogg, Kenneth K. W. Lee, Amer H. Zureikat and Alessandro Paniccia have no conflicts of interest or financial ties to disclose

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Mungo, B., Hammad, A., AlMasri, S. et al. Pancreaticoduodenectomy for benign and premalignant pancreatic and ampullary disease: is robotic surgery the better approach?. Surg Endosc 37, 1157–1165 (2023). https://doi.org/10.1007/s00464-022-09632-w

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