From totally laparoscopic to pure robotic pancreatoduodenectomy: A propensity score matching analysis of a single-center experience.

Abstract

Application of minimally invasive approaches has met some resistance in pancreaticoduodenectomy because of the technical complexity of the operation and the specific skills required. Use of the robotic approach is increasing, but corroborated results still lack in differentiating outcomes after laparoscopic pancreaticoduodenectomy from outcomes after robotic pancreaticoduodenectomy. Data of patients undergoing minimally invasive pancreaticoduodenectomy between 2017 and 2024 were considered. The primary end point was severe complications. To reduce biases, a 1:1 propensity score matching was applied. The laparoscopic pancreaticoduodenectomy group included 119 patients, and the robotic pancreaticoduodenectomy group included 101 patients. After propensity score matching, each group comprised 85 patients. Severe complications were comparable between the 2 groups (laparoscopic pancreaticoduodenectomy 25.9% vs robotic pancreaticoduodenectomy 29.4%, P = .607). No differences were found in pancreas-specific complications and mortality, whereas length of stay was shorter in robotic pancreaticoduodenectomy (16 days vs 11 days, P = .046). Robotic pancreaticoduodenectomy also had lower operative time (545 minutes vs 505 minutes, P < .001) and blood loss (300 mL vs 200 mL, P = .010). Patients treated for malignant disease did not show differences in R0 rate and lymph nodes harvested. Robotic pancreaticoduodenectomy was comparable to laparoscopic pancreaticoduodenectomy in terms of complications and had reduced operative time, blood loss, and length of stay.