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Robotic versus open pancreaticoduodenectomy for distal cholangiocarcinoma: a multicenter propensity score-matched study

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Abstract

Background

Pancreatoduodenectomy is the only potentially curative treatment for distal cholangiocarcinoma (DCC). In this study, we sought to compare the perioperative and oncological outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) based on a multicenter propensity score-matched study.

Methods

Consecutive patients with DCC who underwent RPD or OPD from five centers in China between January 2014 and June 2019 were included. A 1:1 propensity score matching (PSM) was performed. 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

A total of 217 patients and 228 patients underwent RPD and OPD, respectively. After PSM, 180 patients in each group were enrolled. There were no significant differences in operative time, lymph node harvest, intraoperative transfusion, vascular resection, R0 resection, postoperative major morbidity, reoperation, 90-day mortality, and long-term survival between the two groups before and after PSM. Whereas, compared with the OPD group, the RPD group had significantly lower estimated blood loss (150.0 ml vs. 250.0 ml; P < 0.001), and a shorter postoperative length of stay (LOS) (12.0 days vs. 15.0 days; P < 0.001). Multivariable analysis showed carbohydrate antigen 19-9 (CA19-9), R0 resection, N stage, perineural invasion, and tumor differentiation significantly associated with OS and RFS of these patients.

Conclusions

RPD was comparable to OPD in feasibility and safety. For patients with DCC, RPD resulted in similar oncologic and survival outcomes as OPD.

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Data availability

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

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Acknowledgements

We would like to sincerely thank the Chinese Alliance of Hepato-Biliary-Pancreatic Surgery, including Bing Han, from Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Jian-Lei Yuan, from Department of Hepatobiliary and Pancreatic Surgery, People Hospital of Cangzhou city, Cangzhou, Hebei, China; Wei Wang, from the Department of General Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; and Jia-Ning Liu, from Department of Thyroid and Pancreatic Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China, for their valuable data.

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Author notes

  1. Shuai Xu, Xiu-Ping Zhang, Guo-Dong Zhao and Wen-Bo Zou have contributed equally to this manuscript.

Authors and Affiliations

  1. Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Shuai Xu, Xiu-Ping Zhang, Guo-Dong Zhao, Wen-Bo Zou, Zhi-Ming Zhao, Ming-Gen Hu, Yuan-Xing Gao, Xiang-Long Tan, Qu Liu & Rong Liu

  2. School of Medicine, Nankai University, Tianjin, China

    Shuai Xu & Rong Liu

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Contributions

Conception and design: RL, SX, X-PZ, G-DZ; Provision of study materials or patients: Z-MZ, G-DZ, M-GH, Y-XG, X-LT, QL; Collection and assembly of data: SX, X-PZ, W-BZ; Data analysis and interpretation: SX, X-PZ, W-BZ; Manuscript writing: SX, X-PZ, G-DZ; Final approval of manuscript: All authors. Financial support: RL.

Corresponding author

Correspondence to Rong Liu.

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Disclosures

Dr. Shuai Xu, Xiu-Ping Zhang, Guo-Dong Zhao, Wen-Bo Zou, Zhi-Ming Zhao, Ming-Gen Hu, Yuan-Xing Gao, Xiang-Long Tan, Qu Liu, and Rong Liu have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by the Ethics Committee of the five hospitals (S2020-252-09).

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Written informed consent was obtained from all patients.

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Xu, S., Zhang, XP., Zhao, GD. et al. Robotic versus open pancreaticoduodenectomy for distal cholangiocarcinoma: a multicenter propensity score-matched study. Surg Endosc 36, 8237–8248 (2022). https://doi.org/10.1007/s00464-022-09271-1

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