Robotic pancreatoduodenectomy reduces grade B pancreatic fistula in patients with a small main pancreatic duct: a propensity score-matched study compared to laparoscopic pancreatoduodenectomy.

BACKGROUND

The benefits of robotic pancreaticoduodenectomy (RPD) over laparoscopic pancreaticoduodenectomy (LPD) remain less reported, this study aimed to evaluate the superiority of RPD over LPD.

METHODS

A retrospective 1:1 propensity score-matched (PSM) analysis of the characteristics and perioperative variables of patients who underwent RPD and LPD between January 2021 and June 2023 in a high-volume centre was performed.

RESULTS

The analysis included 193 patients who underwent RPD and 355 who underwent LPD. After PSM, 173 patients who underwent RPD were matched with 173 who underwent LPD cases. RPD was associated with a shorter operative time [341 (302-363) vs. 447 (380-510) min;  = 0.001], lower blood loss [105 (50-110) vs. 200 (105-200) ml;  < 0.001], and a shorter postoperative hospital stay [12 (10-23) vs. 15 (12-24) days;  = 0.031]. No significant differences were observed between the two groups in terms of complication grade ( = 0.227), number of lymph nodes harvested (19.01 ± 8.32 vs. 19.95 ± 9.42;  = 0.099). In patients with main pancreatic duct of small diameter (≤3 mm), RPD was associated with fewer grade B pancreatic fistula (16.3% vs. 32.0%;  = 0.045).

CONCLUSION

RPD is as safe and feasible a minimally invasive approach as LPD is. The robotic approach in pancreatoduodenectomy could decrease grade B pancreatic fistula rate in patients with a main pancreatic duct of small diameter and reduce the operative time, blood loss and postoperative hospital stays.