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ROBOTIC VS. OPEN PANCREATICODUODENECTOMY: A PROPENSITY-MATCHED ANALYSIS OF SHORT-TERM OUTCOMES, COSTS, AND OPIOID USE IN THE FIRST 5 YEARS OF A YEARS OF A U.S. CANCER CENTER'S ROBOTIC SURGICAL ONCOLOGY PROGRAM
Anneliese N. Hierl
*, Elsa M. Arvide, Morgan L. Bruno, Whitney L. Dewhurst, Laura R. Prakash, Rebecca A. Snyder, Michael P. Kim, Jessica E. Maxwell, Hop S. Tran Cao, Ching-Wei D. Tzeng, Matthew Katz, Naruhiko Ikoma
University of Texas MD Anderson Cancer Center, Houston, TX
Background: The safety and cost-effectiveness of robotic pancreatic surgery, especially during early surgeon experience, is not well established. We compared 90-day outcomes, oral morphine equivalents (OMEs), and costs of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) during the implementation phase of an RPD program at a non-expert robotic center.
Methods: We reviewed patients who underwent RPD or OPD at our center from 1/2018 to 5/2024, including initial robotic cases, excluding those requiring vascular resection. All RPDs were performed by a single surgeon[Hi1] , while multiple surgeons performed OPDs. Clinical data and 90-day postoperative outcomes were collected from a prospective database. Cost data were obtained from the financial department then converted into ratios relative to the average OPD costs. The analysis focused on the 30-day postoperative period to exclude the effects of adjuvant chemotherapy. A 1:2 propensity score matching (PSM) method was used to compare cohorts based on age, sex, BMI, ASA, and surgery indication.
Results: We identified a total of 499 patients, including 63 RPD and 436 OPD patients. After matching, 189 patients were included in the analysis, with 63 RPD and 126 OPD patients. The median age of patients was 65 years (IQR: 55-70) and median BMI was 27 kg/m
2 (IQR: 24-30 kg/m
2).
Comparisons of the matched cohorts demonstrate that RPD patients had significantly lower estimated blood loss (100 vs 200 cc, p<0.001). RPD had longer case durations (491 min vs 437 min, p<0.001) but shorter lengths of stay (4 vs 5, p<0.001). There were no significant differences between the RPD and OPD groups in terms of Accordion grade
> 3 [TD2] (27 vs 29 %, p=0.82), DGE (11 vs 14%, p=0.54), biliojejunal leak (3.2 vs 3.2%, p=1), chyle leak (9.5 vs 8.7%, p=0.86), postoperative transfusion rate (8 vs 10%, p=0.72), infectious complications (29 vs 26.%, p=0.73), or 90-day readmissions (32 vs 36%, p=0.59). There was no difference in biochemical leaks (17 vs 13%, p=0.38), POPF grade B (16 vs. 18%, p=0.68) or grade C POPF (2 vs. 1%, p=1).
In terms of costs, the intraoperative cost ratio was significantly higher for RPD patients (CR: 1.32 vs 1.00, p<0.001). However, inpatient cost (1.12 vs 1.39, p<0.001), readmission cost (0.82 vs. 1.12, p=0.74) and 30-day perioperative cost ratio (2.72 vs. 2.81, p=0.65) were significantly lower for RPD. OMEs were significantly lower for RPD patients compared to OPD for both POD0-2 (74 vs. 155, p<0.001) and total inpatient (76 vs. 197, p<0.001).
Conclusion: RPD showed similar 90-day outcomes to OPD in our early robotic program, with comparable 30-day perioperative costs despite higher intraoperative expenses. RPD's benefits were mainly limited to minor differences in LOS and opioid use. Further research is needed to explore quality-of-life benefits and optimal patient selection for RPD.
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