Published online Jan 27, 2023. doi: 10.4240/wjgs.v15.i1.60
Peer-review started: July 11, 2022
First decision: November 18, 2022
Revised: November 23, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 27, 2023
Despite all advancements pancreatic ductal adenocarcinoma is still considered one of the deadliest types of cancer with an overall 5-year survival of only 10.8%. Pancreaticoduodenectomy (PD) is the only potentially curative approach for resectable pancreatic cancer (PC) and robotic PD has gain popularity in recent years.
Recent literature suggests that relatively new robotic PD approach offers comparable or even slightly improved short-term outcomes and equivalent rates of postoperative complications, however the data regarding long-term oncologic outcomes are limited. On the other hand, new studies demonstrated superior lymph node (LN) harvest using the robotic PD platform that could be an important predictor of recurrence and survival. Hence, we decided to analyze the National Cancer Database (NCDB) and compare open, laparoscopic and robotic PD in terms of absolute number of LN harvest and association of lymph node yield with long-term oncological outcomes.
The primary outcome was to evaluate absolute LN harvest during open, laparoscopic and robotic PD. Secondary outcomes included evaluating the association between LN harvest and short- and long-term oncological outcomes for three different surgical approaches, and more specifically - the association of LN harvest with overall survival (OS).
Retrospective analysis of NCDB patients diagnosed with PC who underwent PD in 2010-2018. One-way analysis of variance was used for continuous variables, chi-square test - for categorical. OS was defined as the time between surgery and death. Median survival time was estimated with the Kaplan-Meier method, and groups were compared with the Wilcoxon test. A Cox proportional hazard model was used to access the association of covariates with survival after controlling for patient characteristics and procedure type.
17169 patients were included in the final analysis. 13816 (80.5%) patients had an open PD, 2677 (15.6%) and 676 (3.9%) - laparoscopic and robotic PD respectively. On average 18.84 LNs were harvested during PD. Mean LN harvest during open, laparoscopic and robotic PD was 18.59, 19.65 and 20.70 LNs respectively (P < 0.001). On average, 2.49 LNs were positive for cancer and did not differ by the procedure type (P = 0.26). Median survival for open PD was 26.1 mo, laparoscopic - 27.2 mo, robotic - 29.1 mo (P = 0.064). Survival was associated with higher number of positive LN harvest, while higher number of positive LNs was associated with higher mortality.
Our study demonstrated that robotic PD was associated with increased number of lymph nodes harvested during surgery and equivalent to open and laparoscopic approaches with respect to short-term oncological outcomes and overall survival. This supports the continued incorporation of robotic PD into the surgical treatment of pancreatic neoplasms.
Our study provides new evidence on superior LN harvest and comparable overall survival of patients undergoing robotic PD and warrants attention. Additional prospective studies directly comparing robotic and open approaches are needed to validate our findings and to further endorse utilization of the robotic surgical platform.