Lixin Chen, Shuai Yuan, Qiang Xu, Ming Cui, Pengyu Li, Wenjing Liu, Chen Lin, Weijie Chen, Haomin Chen, Ya Hu, Menghua Dai
{"title":"Outcomes evaluation of robotic versus laparoscopic pancreaticoduodenectomy: a propensity score matching and learning curve analysis.","authors":"Lixin Chen, Shuai Yuan, Qiang Xu, Ming Cui, Pengyu Li, Wenjing Liu, Chen Lin, Weijie Chen, Haomin Chen, Ya Hu, Menghua Dai","doi":"10.1007/s00464-025-11684-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Limited research has been conducted on the short-term outcomes comparing laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), particularly in the post-learning curve stage. This study aims to investigate surgical efficacy and provide clinical practices for selecting suitable techniques between LPD and RPD.</p><p><strong>Methods: </strong>A retrospective study was conducted on consecutive patients who underwent RPD and LPD between April 2016 and December 2023. Baseline characteristics, pathological information, and perioperative data were analyzed. Propensity score matching (PSM) analysis was performed to ensure the comparability of important factors between the groups.</p><p><strong>Results: </strong>A total of 277 patients were enrolled in the study, of which 145 underwent RPD. Following PSM, 116 patients were included in each group and baseline characteristics were well matched. The RPD group demonstrated a lower conversion rate to laparotomy (5.2% vs. 18.1%, p = 0.002), reduced blood loss (350 vs. 500 ml, p = 0.031), and a higher rate of R0 resection (91.4% vs. 80.7%, p < 0.05) compared to the laparoscopic group. The incidence of B2-Grade postoperative pancreatic fistula (B2-POPF) was also lower in the RPD group compared to the LPD group (4.3% vs. 11.2%, p = 0.037). Among patients in the post-learning curve stage, perioperative outcomes were similar between the two groups.</p><p><strong>Conclusion: </strong>RPD offered several advantages over LPD, including lower rates of conversion to open and blood loss, higher rates of R0 resection, and improved POPF outcomes. Other perioperative outcomes were comparable between the two groups. Both techniques appeared feasible and safe in experienced surgeons, though RPD was preferred in complex cases.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3681-3690"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Endoscopy And Other Interventional Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00464-025-11684-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/30 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Limited research has been conducted on the short-term outcomes comparing laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), particularly in the post-learning curve stage. This study aims to investigate surgical efficacy and provide clinical practices for selecting suitable techniques between LPD and RPD.
Methods: A retrospective study was conducted on consecutive patients who underwent RPD and LPD between April 2016 and December 2023. Baseline characteristics, pathological information, and perioperative data were analyzed. Propensity score matching (PSM) analysis was performed to ensure the comparability of important factors between the groups.
Results: A total of 277 patients were enrolled in the study, of which 145 underwent RPD. Following PSM, 116 patients were included in each group and baseline characteristics were well matched. The RPD group demonstrated a lower conversion rate to laparotomy (5.2% vs. 18.1%, p = 0.002), reduced blood loss (350 vs. 500 ml, p = 0.031), and a higher rate of R0 resection (91.4% vs. 80.7%, p < 0.05) compared to the laparoscopic group. The incidence of B2-Grade postoperative pancreatic fistula (B2-POPF) was also lower in the RPD group compared to the LPD group (4.3% vs. 11.2%, p = 0.037). Among patients in the post-learning curve stage, perioperative outcomes were similar between the two groups.
Conclusion: RPD offered several advantages over LPD, including lower rates of conversion to open and blood loss, higher rates of R0 resection, and improved POPF outcomes. Other perioperative outcomes were comparable between the two groups. Both techniques appeared feasible and safe in experienced surgeons, though RPD was preferred in complex cases.
背景：关于腹腔镜胰十二指肠切除术（LPD）和机器人胰十二指肠切除术（RPD）的短期结果比较的研究有限，特别是在学习曲线后阶段。本研究旨在探讨LPD与RPD的手术效果，为选择合适的手术方式提供临床依据。方法：对2016年4月至2023年12月期间连续接受RPD和LPD治疗的患者进行回顾性研究。分析基线特征、病理信息和围手术期资料。采用倾向评分匹配（PSM）分析，确保各组间重要因素的可比性。结果：共有277例患者入组，其中145例患者接受了RPD。PSM后，每组116例患者，基线特征匹配良好。RPD组表现出较低的开腹转换率（5.2% vs. 18.1%, p = 0.002），减少的出血量（350 vs. 500 ml, p = 0.031）和较高的R0切除术率(91.4% vs. 80.7%， p结论：RPD比LPD有几个优势，包括较低的开腹转换率和出血量，较高的R0切除术率和改善的POPF结果。两组之间的其他围手术期结果具有可比性。这两种技术在经验丰富的外科医生看来都是可行和安全的，尽管RPD在复杂病例中更受欢迎。
期刊介绍：
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
