• Qu Liu, Zhiming Zhao, Xiuping Zhang, Wei Wang, Bing Han, Xiong Chen, Xiaodong Tan, Shuai Xu, Guodong Zhao, Yuanxing Gao, Qin Gan, Jianlei Yuan, Yuntao Ma, Ye Dong, Zhonghua Liu, Hailong Wang, Fangyong Fan, Jianing Liu, Wan Yee Lau, and Rong Liu.
• Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
• Ann. Surg. 2023 Apr 1; 277 (4): e864e871e864-e871.

ObjectivesThis study aimed to perform a multicenter comparison between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD).BackgroundPrevious comparisons of RPD versus OPD have only been carried out in small, single-center studies of variable quality.MethodsConsecutive patients who underwent RPD (n = 1032) or OPD (n = 1154) at 7 centers in China between July 2012 and July 2020 were included. A 1:1 propensity score matching (PSM) was performed.ResultsAfter PSM, 982 patients in each group were enrolled. The RPD group had significantly lower estimated blood loss (EBL) (190.0 vs 260.0 mL; P < 0.001), and a shorter postoperative 1length of hospital stay (LOS) (12.0 (9.0-16.0) days vs 14.5 (11.0-19.0) days; P < 0.001) than the OPD group. There were no significant differences in operative time, major morbidity including clinically relevant postoperative pancreatic fistula (CR-POPF), bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage (PPH), reoperation, readmission or 90-day mortality rates. Multivariable analysis showed R0 resection, CR-POPF, PPH and reoperation to be independent risk factors for 90-day mortality. Subgroup analysis on patients with pancreatic ductal adenocarcinoma (PDAC) (n = 326 in each subgroup) showed RPD had advantages over OPD in EBL and postoperative LOS. There were no significant differences in median disease-free survival (15.2 vs 14.3 months, P = 0.94) or median overall survival (24.2 vs 24.1 months, P = 0.88) between the 2 subgroups.ConclusionsRPD was comparable to OPD in feasibility and safety. For patients with PDAC, RPD resulted in similar oncologic and survival outcomes as OPD.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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