A recent open-label randomized trial conducted in China assessed the feasibility and safety of robot-assisted pancreatoduodenectomy compared to open surgery for pancreatic head or periampullary tumors. The study aimed to evaluate short-term outcomes, including postoperative hospital length of stay, operating times, blood loss, and complications. The study was published in the journal Lancet Gastroenterology and Hematology by Prof Qu Liu and colleagues.
Pancreatoduodenectomy is a complex surgical procedure commonly used to treat pancreatic and periampullary tumors. Robot-assisted surgery has gained attention as a potential alternative to open surgery, offering potential advantages such as shorter hospital stays and reduced blood loss. However, conclusive evidence regarding its efficacy and safety compared to traditional open surgery has been limited.
The multicenter trial involved 164 patients randomly assigned to either robot-assisted or open pancreatoduodenectomy. Highly experienced surgeons performed the procedures, with five surgeons from high-volume hospitals participating. The study evaluated short-term outcomes, including postoperative hospital length of stay, operating times, blood loss, complications, readmission rates, and mortality.
Key Findings:
Robot-assisted pancreatoduodenectomy significantly reduced postoperative hospital length of stay compared to open surgery (median 11 vs. 13.5 days).
Robot-assisted surgery also demonstrated shorter operating times (245 vs. 298 minutes) and reduced blood loss (75 vs. 150 mL).
Complication rates, readmission rates, and mortality were similar between the two groups.
Pathology outcomes, including tumor characteristics, were comparable between the robotic and open surgery groups.
The trial concluded that robot-assisted pancreatoduodenectomy is feasible and safe, with modest improvements in short-term outcomes compared to open surgery. While the study focused on short-term benefits, the long-term oncological outcomes require further investigation.
Despite the promising results, the generalizability of the findings may be limited, and the clinical benefit of robot-assisted surgery should be carefully weighed against the associated costs. Future research should prioritize assessing long-term oncological outcomes and maintaining comprehensive registries for outcome tracking in robot-assisted pancreatoduodenectomy.
Reference:
Liu Q, et al "Effect of robotic versus open pancreaticoduodenectomy on postoperative length of hospital stay and complications for pancreatic head or periampullary tumours: a multicentre, open-label randomised controlled trial" Lancet Gastroenterol Hepatol 2024; DOI: 10.1016/S2468-1253(24)00005-0. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00005-0/abstract