Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Niccolò Napoli; Emanuele Federico Kauffmann; Michael Ginesini; Armando Di Dato; Virginia Viti; Cesare Gianfaldoni; Lucrezia Lami; Carla Cappelli; Maria Isabella Rotondo; Daniela Campani; Gabriella Amorese; Caterina Vivaldi; Silvia Cesario; Laura Bernardini; Enrico Vasile; Fabio Vistoli; Ugo Boggi

doi:10.1097/AS9.0000000000000409

Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Ann Surg Open. 2024 Mar 26;5(2):e409. doi: 10.1097/AS9.0000000000000409. eCollection 2024 Jun.

Authors

Niccolò Napoli¹, Emanuele Federico Kauffmann¹, Michael Ginesini¹, Armando Di Dato¹, Virginia Viti¹, Cesare Gianfaldoni¹, Lucrezia Lami¹, Carla Cappelli², Maria Isabella Rotondo³, Daniela Campani³, Gabriella Amorese⁴, Caterina Vivaldi⁵, Silvia Cesario⁶, Laura Bernardini⁶, Enrico Vasile⁶, Fabio Vistoli¹, Ugo Boggi¹

Affiliations

¹ From the Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
² Division of Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
³ Division of Pathology, University of Pisa, Pisa, Italy.
⁴ Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
⁵ Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
⁶ Division of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

Abstract

Objective: This study aimed to compare robotic pancreatoduodenectomy with vein resection (PD-VR) based on the incidence of severe postoperative complications (SPC).

Background: Robotic pancreatoduodenectomy has been gaining momentum in recent years. Vein resection is frequently required in this operation, but no study has compared robotic and open PD-VR using a matched analysis.

Methods: This was an intention-to-treat study designed to demonstrate the noninferiority of robotic to open PD-VR (2011-2021) based on SPC. To achieve a power of 80% (noninferiority margin:10%; α error: 0.05; ß error: 0.20), a 1:1 propensity score-matched analysis required 35 pairs.

Results: Of the 151 patients with PD-VR (open = 115, robotic = 36), 35 procedures per group were compared. Elective conversion to open surgery was required in 1 patient with robotic PD-VR (2.9%). One patient in both groups experienced partial vein thrombosis. SPC occurred in 7 (20.0%) and 6 patients (17.1%) in the robotic and open PD-VR groups, respectively (P = 0.759; OR: 1.21 [0.36-4.04]). Three patients died after robotic PD-VR (8.6%) and none died after open PD-VR (P = 0.239). Robotic PD-VR was associated with longer operative time (611.1 ± 13.9 minutes vs 529.0 ± 13.0 minutes; P < 0.0001), more type 2 vein resection (28.6% vs 5.7%; P = 0.0234) and less type 3 vein resection (31.4% vs 71.4%; P = 0.0008), longer vein occlusion time (30 [25.3-78.3] minutes vs 15 [8-19.5] minutes; P = 0.0098), less blood loss (450 [200-750] mL vs 733 [500-1070.3] mL; P = 0.0075), and fewer blood transfusions (intraoperative: 14.3% vs 48.6%; P = 0.0041) (perioperative: 14.3% vs 60.0%; P = 0.0001).

Conclusions: In this study, robotic PD-VR was noninferior to open PD-VR for SPC. Robotic and open PD-VR need to be compared in randomized controlled trials.

Keywords: pancreatoduodenectomy with vascular resection; propensity scored matched comparison; robotic pancreatoduodenectomy with vascular resection; robotic pancreatoduodenectomy with vein resection.