• Nine de Graaf, Maurice J W Zwart, Jony van Hilst, Bram van den Broek, Bert A Bonsing, Olivier R Busch, CoenePeter-Paul L OPLODepartment of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands., Freek Daams, Susan van Dieren, van EijckCasper H JCHJDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Sebastiaan Festen, de HinghIgnace H J TIHJTDepartment of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Daan J Lips, LuyerMisha D PMDP0000-0002-9483-1520Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., MieogJ Sven DJSD0000-0002-3649-8504Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands., Hjalmar C van Santvoort, George P van der Schelling, StommelMartijn W JMWJ0000-0002-4257-5254Deptartment of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Roeland F de Wilde, I Quintus Molenaar, Bas Groot Koerkamp, and Marc G Besselink.
• Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
• Br J Surg. 2024 Jan 31; 111 (2).

BackgroundAlthough robotic pancreatoduodenectomy has shown promising outcomes in experienced high-volume centres, it is unclear whether implementation on a nationwide scale is safe and beneficial. The aim of this study was to compare the outcomes of the early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy in the Netherlands.MethodsThis was a nationwide retrospective cohort study of all consecutive patients who underwent robotic pancreatoduodenectomy or open pancreatoduodenectomy who were registered in the mandatory Dutch Pancreatic Cancer Audit (18 centres, 2014-2021), starting from the first robotic pancreatoduodenectomy procedure per centre. The main endpoints were major complications (Clavien-Dindo grade greater than or equal to III) and in-hospital/30-day mortality. Propensity-score matching (1 : 1) was used to minimize selection bias.ResultsOverall, 701 patients who underwent robotic pancreatoduodenectomy and 4447 patients who underwent open pancreatoduodenectomy were included. Among the eight centres that performed robotic pancreatoduodenectomy, the median robotic pancreatoduodenectomy experience was 86 (range 48-149), with a 7.3% conversion rate. After matching (698 robotic pancreatoduodenectomy patients versus 698 open pancreatoduodenectomy control patients), no significant differences were found in major complications (40.3% versus 36.2% respectively; P = 0.186), in-hospital/30-day mortality (4.0% versus 3.1% respectively; P = 0.326), and postoperative pancreatic fistula grade B/C (24.9% versus 23.5% respectively; P = 0.578). Robotic pancreatoduodenectomy was associated with a longer operating time (359 min versus 301 min; P < 0.001), less intraoperative blood loss (200 ml versus 500 ml; P < 0.001), fewer wound infections (7.4% versus 12.2%; P = 0.008), and a shorter hospital stay (11 days versus 12 days; P < 0.001). Centres performing greater than or equal to 20 robotic pancreatoduodenectomies annually had a lower mortality rate (2.9% versus 7.3%; P = 0.009) and a lower conversion rate (6.3% versus 11.2%; P = 0.032).ConclusionThis study indicates that robotic pancreatoduodenectomy was safely implemented nationwide, without significant differences in major morbidity and mortality compared with matched open pancreatoduodenectomy patients. Randomized trials should be carried out to verify these findings and confirm the observed benefits of robotic pancreatoduodenectomy versus open pancreatoduodenectomy.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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