Robotic versus Laparoscopic Distal Pancreatectomy for Upfront Resectable Pancreatic Cancer: An International Retrospective Cohort Study

Introduction: Robotic distal pancreatectomy (RDP) is an upcoming alternative for laparoscopic distal pancreatectomy (LDP). Yet, the oncological efficacy of RDP is uncertain. We compared the oncological and surgical outcomes between RDP and LDP. Methods: An international retrospective cohort study in 34 high-volume centers from 11 countries (2010-2019). The primary outcomes were R0-resection and lymph node yield. Kaplan-Meier estimates were used for survival rates. Results: Overall, 542 patients were included, 103 (19%) underwent RDP and 439 (81%) LDP. Preoperative characteristics were similar. RDP had a higher median lymph-node yield (18 vs 16, P=0.021) and a comparable R0-resection rate (76% vs 69%, P=0.40). RDP had a longer operative time (290 min vs 240 min, P<0.001) and less conversions (5% vs 17%, P=0.001) without emergency conversions (i.e. for bleeding), whereas 29% of conversions during LDP were emergency. RDP had a higher rate of major morbidity (Clavien-Dindo ≥3a) (26% vs 16%, P=0.017), but 30-day mortality and in-hospital mortality showed no significant difference. Median length of hospital stay was longer following RDP (10 vs 8 days, P=0.001). The 3-year survival rate [34% vs 38%, P=0.73] and median overall survival [22 months (95% CI, 12-32) vs 29 months (95% CI, 24-34), P=0.60] did not differ significantly. Conclusion: For upfront resectable pancreatic cancer, RDP was associated with a similar R0-resection rate, but a higher lymph node yield compared to LDP. Given the contradicting outcomes in conversion rate, morbidity rate, operative time, and hospital stay, randomized trials are required in centers that have surpassed the learning curve.