What are the true benefits of robotic pancreaticoduodenectomy for patients with pancreatic cancer?

ABSTRACT

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease, and multimodal treatment including high-quality surgery can improve survival outcomes. Pancreaticoduodenectomy (PD) has evolved with minimally invasive approaches including the implementation of robotic PD (RPD). In this special report, we review the literature whilst evaluating the ‘true benefits’ of RPD compared to open approach for the treatment of PDAC.

Areas covered

We have performed a mini-review of studies assessing PD approaches and compared intraoperative characteristics, perioperative outcomes, post-operative complications and oncological outcomes.

Expert opinion

RPD was associated with similar or longer operative times, and reduced intra-operative blood loss. Perioperative pain scores were significantly lower with shorter lengths of stay with the robotic approach. With regards to post-operative complications, post-operative pancreatic fistula rates were similar, with lower rates of clinically relevant fistulas after RPD. Oncological outcomes were comparable or superior in terms of margin status, lymph node harvest, time to chemotherapy and survival between RPD and OPD. In conclusion, RPD allows safe implementation of minimally invasive PD. The current literature shows that RPD is either equivalent, or superior in certain aspects to OPD. Once more centers gain sufficient experience, RPD is likely to demonstrate clear superiority over alternative approaches.

KEYWORDS:

• Pancreatic cancer
• pancreatic adenocarcinoma
• pancreaticoduodenectomy
• Whipple
• robotic surgery

Article highlights

• RPD is associated with similar or longer operative times, but reduced intra-operative blood loss.

• Perioperative pain scores are significantly lower, with shorter length of stay with the robotic approach.

• Post-operative pancreatic fistula rates are similar with lower rates of clinically relevant fistulas after RPD.

• Oncological outcomes are comparable, or superior in terms of margin status, lymph node harvest, time to chemotherapy and survival between RPD and OPD.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.