P. Briceno1, R. Shridhar3, J. Huston1, S. Kucera2, K. Meredith1 1Florida State University College Of Medicine/Sarasota Memorial Health Care System,Gastrointestinal Oncology,Sarasota, FL, USA 2Florida State University College Of Medicine,Endoscopic Oncology,Sarasota, FL, USA 3University Of Central Florida,Radiation Oncology,Orlando, FL, USA
Introduction: Surgery remains a key component of treatment for resectable pancreatic adenocarcinoma. Mortality rates have dropped dramatically over the past several decades with improvements in preoperative care, intraoperative surgical techniques and instrumentation, as well as post-operative care. However, improving outcomes from pancreatic resection through minimally invasive surgical approaches has gained interest. While there is widespread adoption of both laparoscopic and robotic resections for cancers of the left pancreas the demanding technical requirements of performing a minimally invasive pancreaticoduodenectomy (RPD) and prolonged learning curve have proven to difficult for most. There are several reports of operative outcomes for patients undergoing robotic pancreatic resections, however the survival in these patients has not been investigated.
Methods: Utilizing the National Cancer Database we identified patients who underwent pancreatic resection. We then stratified by operative approach. Outcomes of patients were then compared between open(OP), robotic(RP) and laparoscopic(LP) approaches. Baseline univariate comparisons of patient characteristics were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson’s Chi-square test was used to compare categorical variables. Survival was evaluated on the basis of time from date of diagnosis to date of death or censoring. Unadjusted survival analyses were performed using the Kaplan-Meier method comparing survival curves with the log-rank test. All statistical tests were two-sided and α (type I) error <0.05 was considered statistically significant.
Results: We identified N = 17,738 patients who underwent pancreatic resection with a median age of 66 (18-90) years. There were 14,568 open, 2,739 laparoscopic, and 431 robotic. There were 7943 open whipples (OW) and 3455 open distal pancreatectomies (ODP). Within the minimally invasive approaches there were 1123 (41%) laparoscopic whipples (LW), 1616 (59%) laparoscopic distal pancreatectomies (LDP), 122 (28.3%) robotic whipple (RW), and 309 (71.7%) robotic distal pancreatectomies (RDP). The 30-day mortality between OP, LP and RP was 3.5%, 2.8%, and 2.6%, p=0.1 however the 90-day mortality was 7.2%, 5.8%, and 4.6%, p=0.004. R0 resections were performed in 78.5% OP, 83.7% LP, and 86.3% RP, p<0.001. The median survival was 30.1 months OP, 37.7 months LP, and 52.3 months RP, p<0.001. However, RP and LP had higher T1 and T2 as well as node negative patients p<0.001 and p<0.001 respectively. Conversions to open occurred in 24.2% LP and 13.9% RP, p<0.001. Within the LDP and RDP there were 351 (21.7%) and 36 (11.7%) conversions, p<0.001. The LW and RW demonstrated 308 (27.4%) and 29 (23.8%) conversions, p=0.4.
Conclusion: Our analysis indicates that robotic assisted pancreatic resections are at least equivalent in oncologic outcomes to standard open approaches. Robotic techniques resulted in fewer conversions to open compared to laparoscopic approaches particularly in the distal pancreatectomy cohorts.