Nationwide implementation and perioperative outcomes of robotic distal pancreatectomy for malignancy: A propensity score matched analysis in Japan.

Abstract

Minimally invasive distal pancreatectomy (DP) leads to improved recovery compared with open DP; however, robotic DP recovery data are limited, based on small, expert-center studies. We aimed to compare perioperative outcomes of robotic, open, and laparoscopic DP for malignant disease in a nationwide cohort within a nationally credentialed implementation program. Japanese National Clinical Database data were obtained, capturing >95% of all surgical procedures performed nationwide. Patients who underwent DP between 2019 and 2023 were identified, and outcomes of robotic, open, and laparoscopic DP were compared using propensity score matching. Among 12,124 DPs, 921 robotic-open and 920 robotic-laparoscopic matched pairs were analyzed. Compared with open DP, robotic DP showed a trend toward lower rates of overall Clavien-Dindo ≥ III complications (15.5% vs 18.5%; P = .09) and clinically relevant pancreatic fistula (16.9% vs 20.2%; P = .07), with reduced blood loss (67 vs 280 mL; P < .001) and longer operative time. Hospital stay was shorter; however, 30-day readmission was higher for robotic DP. Compared with laparoscopic DP, robotic DP exhibited lower conversion (2.6% vs 6.6%; P < .001), reduced blood loss (66 vs 100 mL; P < .001), longer operative time, comparable morbidity, and marginally shorter hospitalization periods. Deep venous thrombosis occurred more frequently after robotic DP in both comparisons. While robotic DP has been safely implemented nationwide, its advantages over laparoscopic DP appear limited, with clear benefits primarily in conversion reduction and reduced intraoperative blood loss. To justify its broader clinical adoption, evaluation of oncologic outcomes and economic implications is warranted.