Oncologic Efficacy of Robotic Compared to Open Total Pancreatectomy for Pancreatic Cancer

Introduction: The use of robotic surgery for pancreatic cancer resections is increasing over time. There are multiple studies comparing this approach to open surgery, specifically for Whipple and distal pancreatectomies. But there are limited data on its feasibility and oncologic efficacy in patients requiring total pancreatectomy.

Methods: This is a retrospective study from the 2010 to 2019 National Cancer Database comparing the postoperative, pathological, and long-term oncologic outcomes between robotic total pancreatectomy (RTP) and open total pancreatectomy (OTP) for pancreatic adenocarcinoma.

Results: One hundred eighty-eight (5%) RTP and 3447 (95%) OTP patients were identified. The number of RTP increased from four in 2010 to 32 in 2019. There were no major differences in patient demographics and treatment characteristics, except that RTP patients were more likely to be performed at nonacademic centers and less likely to get radiation. After adjustment, there was similar yield of examined lymph nodes, rate of positive margin, 90-d mortality and receipt of adjuvant therapy between both groups. RTP was associated with a statistically significant shorter length of stay than OTP (9 versus 11 d respectively, P value <0.001). There was no difference in median overall survival between RTP and OTP (22.3 mo versus 23.3 mo, P value 0.688). The 1-, 3-, and 5-y overall survival rates for RTP were 78%, 31%, and 34% and those for OTP were 75%, 38%, and 30%, respectively. After adjustment, the use of robotic surgery was associated with similar overall survival to the open approach (hazard ratio 0.939, 95% confidence interval 0.760-1.161).

Conclusions: RTP is associated with similar short- and long-term mortality without sacrificing oncologic outcomes including adequate lymphadenectomy and adjuvant chemotherapy receipt with the advantage of shorter length of stay.