CURRENT TRENDS IN THE TYPES OF PANCREATODUODENECTOMY FOCUSING ON THE ROLE OF ROBOT ASSISTED PANCREATODUODENECTOMY
Mirang Lee*, Won-Gun Yun, Hye-Sol Jung, Youngmin Han, Wooil Kwon, Jin-Young Jang
Department of Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
Background: Pancreatoduodenectomy (PD) is the most challenging abdominal surgery requiring elaborate and strenuous procedures. Although laparoscopic PD could not become a standard due to high morbidity, the popularity of robotic PD has recently increased due to many advantages. we investigated current trends of types of PD focusing on the clinical role of robotic surgery.
Methods: Between 2015 and 2022, a total of 1658 PD was performed. 1120 patents underwent open PD, and 538 underwent robotic PD. Demographics and surgical outcomes were analyzed according to time period (first and late period), and propensity score-matched (PSM) analysis was performed to evaluate complications and clinical outcomes.
Results: The proportion of the robotic surgery was increased from 16.0% to 47.1% in the late period. Operation time was longer in the robot group (310.0 vs. 285.0 min, P < 0.001); however, estimated blood loss did not significantly differ (350.0 vs. 400.0 mL, P = 0.190). Complications of C-D grade 3a or higher (21.2% vs. 19.0%, P = 0.298) and CR-POPF rates (10.0% vs. 9.3%, P =0.626) were similar. Hospital stay was shorter in robot PD (8.0 days) than open PD (11.0 days). After PSM analysis, no significant difference of morbidity and there was no statistically significant difference in survival outcome between the two methods (Figure 1,2).
Conclusion: The number of robot PD has markedly increased in a relative short time showing comparable morbidity/mortality and oncologic outcome. Considering better recovery and cosmetic outcome, robot PD has become one of standard surgical method in pancreatic surgery.
figure1 overall survival of malignancy after PSM
figure2 overall survival of pancreatic cancer after PSM
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