Robotic vs Open Pancreaticoduodenectomy Safe, Feasible Among Older Patients

Cancer surgery
Researchers compared the safety and feasibility of robotic vs open pancreaticoduodenectomy among older adults.

Robotic pancreaticoduodenectomy (RPD) shortens operative time and postoperative hospitalization and decreases blood loss compared with open pancreaticoduodenectomy (OPD), according to study findings published in the International Journal of Surgery.

For the analysis, researchers retrospectively evaluated surgical characteristics and outcomes among patients aged 75 years and older who underwent RPD (n=169) or OPD (n=133) at 7 centers in China between 2011 and 2020.

The RPD and OPD cohorts comprised 52.1% and 54.1% men; had a mean age of 76.9±2.0 and 76.5±1.8 years; 88.5% and 91.0% had malignancy; 27.9% and 26.3% had type 2 diabetes; 21.2% and 17.3% had coronary heart disease; and 9.7% and 8.3% had chronic obstructive pulmonary disease, respectively.

RPD was associated with shorter operation times (mean, 264.3 vs 278.2 minutes; P =.01), less blood loss (median, 100 vs 200 ml; P <.001), and shorter postoperative hospital stays (median, 13.0 vs 17.0 days; P <.001). All other perioperative outcomes and complication rates were similar between cohorts.

After the procedure, 8.5% and 6.0% (P =.42) of the RPD and OPD cohorts had hemorrhage, respectively. The 90-day mortality rates were 3.6% for the RPD and 4.5% for the OPD cohorts (P =.70).

Risk for 90-day mortality was associated with postpancreatectomy hemorrhage (odds ratio [OR], 1194.84; 95% CI, 25.35-56,321.34; P <.001), chronic obstructive pulmonary disease (OR, 57.90; 95% CI, 2.95-1138.11; P =.008), cardiac events (OR, 26.91; 95% CI, 1.82-398.67; P =.02), and type 2 diabetes (OR, 17.24; 95% CI, 1.24-239.87; P =.03).

Study limitations include the nonrandomized retrospective design, which may have led to selection bias, and a small sample size.

The study authors concluded, “To our knowledge, this multicenter study is the first to demonstrate that the RPD is comparable to the OPD in terms of safety and feasibility in elderly patients, with shorter OT [operative time], lower EBI [estimated bleeding loss], and shorter postoperative LOS [length of stay]. Surgical approach was not an independent risk factor for 90-day mortality.”

Reference

Liu Q, Jiang N, Tian E, et al. Short-term outcomes of robotic versus open pancreaticoduodenectomy in elderly patients: A multicenter retrospective cohort study. Int J Surg. 2022;104:106819. doi:10.1016/j.ijsu.2022.106819