TY - JOUR
T1 - Oncological outcome after robot-assisted versus open pancreatoduodenectomy for upfront resectable cancer in the pancreatic head
T2 - a nationwide cohort analysis
AU - Menso, Julia E
AU - Bruna, Caro L
AU - Ali, Mahsoem
AU - Bonsing, Bert
AU - Bosscha, Koop
AU - Brosens, Lodewijk A A
AU - Busch, Olivier R
AU - Crobach, A Stijn L P
AU - Daams, Freek
AU - Derksen, Wouter
AU - Dewulf, Maxime J L
AU - Doukas, Michail
AU - Fariña Sarasqueta, Arantza
AU - Festen, Sebastiaan
AU - Abu Hilal, Mohammad
AU - de Hingh, Ignace H J T
AU - Homs, Marjolein Y V
AU - Kazemier, Geert
AU - Lips, Daan J
AU - Luyer, Misha D P
AU - de Meijer, Vincent E
AU - Mieog, J Sven D
AU - Te Riele, Wouter W
AU - van Santvoort, Hjalmar C
AU - van der Schelling, George P
AU - Stommel, Martijn
AU - Verheij, Joanne
AU - de Wilde, Roeland F
AU - Wilmink, Johanna W
AU - Molenaar, I Quintus
AU - Groot Koerkamp, Bas
AU - van der Geest, Lydia G
AU - Besselink, Marc G
N1 - Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.
PY - 2025/11/6
Y1 - 2025/11/6
N2 - Background: Robot-assisted pancreatoduodenectomy (RPD) aims to enhance postoperative recovery compared to open pancreatoduodenectomy (OPD). Although recent randomized trials confirmed the short-term safety of RPD, they did not confirm superiority or assess oncological safety. This nationwide observational cohort study compares oncological outcome after RPD versus OPD in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and distal cholangiocarcinoma (DCC) without vascular contact. Methods: All consecutive patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact on preoperative imaging in the Netherlands were included. Data were obtained from the Netherlands Cancer Registry (2016–2023). Primary outcomes were overall survival (OS) and R0-resection rate. Results: Overall, 1675 patients after pancreatoduodenectomy for upfront resectable PDAC and DCC were included (375 RPD; 1300 OPD). Adjusted median OS was 23 months after RPD versus 22 months after OPD, with comparable 5-year survival rate (23.3% versus 22.4%, HR 0.96 [0.82–1.14], P = 0.665). The R0-resection rate was comparable (57.1% versus 59.7%, P = 0.368). RPD was associated with a shorter hospital stay (median 9 versus 11 days, P < 0.001) and comparable in-hospital/30-day (3.1% versus 2.6%, P = 0.618) and 90-day mortality rate (7.7% versus 6.2%, P = 0.276). In patients with PDAC, no differences in receipt (58.2% versus 58.7%, P = 0.900), time to start (median 54 versus 58 days, P = 0.107), or completion of adjuvant chemotherapy (30.4% versus 30.4%, P = 0.999) were observed. Conclusions: In this nationwide study, oncological outcome including 5-year survival was comparable between patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact without differences in the use of adjuvant therapy for PDAC.
AB - Background: Robot-assisted pancreatoduodenectomy (RPD) aims to enhance postoperative recovery compared to open pancreatoduodenectomy (OPD). Although recent randomized trials confirmed the short-term safety of RPD, they did not confirm superiority or assess oncological safety. This nationwide observational cohort study compares oncological outcome after RPD versus OPD in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and distal cholangiocarcinoma (DCC) without vascular contact. Methods: All consecutive patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact on preoperative imaging in the Netherlands were included. Data were obtained from the Netherlands Cancer Registry (2016–2023). Primary outcomes were overall survival (OS) and R0-resection rate. Results: Overall, 1675 patients after pancreatoduodenectomy for upfront resectable PDAC and DCC were included (375 RPD; 1300 OPD). Adjusted median OS was 23 months after RPD versus 22 months after OPD, with comparable 5-year survival rate (23.3% versus 22.4%, HR 0.96 [0.82–1.14], P = 0.665). The R0-resection rate was comparable (57.1% versus 59.7%, P = 0.368). RPD was associated with a shorter hospital stay (median 9 versus 11 days, P < 0.001) and comparable in-hospital/30-day (3.1% versus 2.6%, P = 0.618) and 90-day mortality rate (7.7% versus 6.2%, P = 0.276). In patients with PDAC, no differences in receipt (58.2% versus 58.7%, P = 0.900), time to start (median 54 versus 58 days, P = 0.107), or completion of adjuvant chemotherapy (30.4% versus 30.4%, P = 0.999) were observed. Conclusions: In this nationwide study, oncological outcome including 5-year survival was comparable between patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact without differences in the use of adjuvant therapy for PDAC.
KW - Aged
KW - Bile Duct Neoplasms/surgery
KW - Carcinoma, Pancreatic Ductal/surgery
KW - Cholangiocarcinoma/surgery
KW - Cohort Studies
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Pancreatic Neoplasms/surgery
KW - Pancreaticoduodenectomy/methods
KW - Registries
KW - Robotic Surgical Procedures/methods
KW - Survival Rate
KW - Treatment Outcome
U2 - 10.1093/bjs/znaf153
DO - 10.1093/bjs/znaf153
M3 - Article
C2 - 41313602
SN - 0007-1323
VL - 112
JO - The British journal of surgery
JF - The British journal of surgery
IS - 11
M1 - znaf153
ER -