Back to Search
Start Over
New perspectives on robotic pancreaticoduodenectomy: An analysis of the National Cancer Database.
- Source :
-
World journal of gastrointestinal surgery [World J Gastrointest Surg] 2023 Jan 27; Vol. 15 (1), pp. 60-71. - Publication Year :
- 2023
-
Abstract
- Background: Pancreatic ductal adenocarcinoma is a common malignancy. Despite all advancements, the prognosis remains, poor with an overall 5-year survival of only 10.8%. Recently, a robotic platform has become an attractive tool for treating pancreatic cancer (PC). While recent studies indicated improved lymph node (LN) harvest during robotic pancreaticoduodenectomy (PD), data on long-term outcomes are insufficient.<br />Aim: To evaluate absolute LN harvest during PD. Secondary outcomes included evaluating the association between LN harvest and short- and long-term oncological outcomes for three different surgical approaches.<br />Methods: We conducted an analysis of the National Cancer Database, including patients diagnosed with PC who underwent open, laparoscopic, or robotic PD in 2010-2018. One-way analysis of variance was used to compare continuous variables, chi-square test - for categorical. Overall survival 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 hazards model was used to assess the association of covariates with survival after controlling for patient characteristics and procedure type.<br />Results: 17169 patients were included, 8859 (52%) males; mean age 65; 14509 (85%) white. 13816 (80.5%) patients had an open PD, 2677 (15.6%) and 676 (3.9%) - laparoscopic and robotic PD respectively. Mean comorbidity index (Charlson-Deyo Score) 0.50. On average, 18.84 LNs were harvested. Mean LN harvest during open, laparoscopic and robotic PD was 18.59, 19.65 and 20.70 respectively ( P < 0.001). On average 2.49 LNs were positive for cancer and did not differ by the procedure type ( P = 0.26). Vascular invasion was noted in 42.6% of LNs and did differ by the approach: 42.1% for open, 44.0% for laparoscopic and 47.2% for robotic PD ( P = 0.015). 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 LN harvest, while higher number of positive LNs was associated with higher mortality.<br />Conclusion: Our study suggests that robotic PD is associated with increased intraoperative LN harvest and has comparable short-term oncological outcomes and survival compared to open and laparoscopic approaches.<br />Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests as well as no financial relationship to disclose.<br /> (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1948-9366
- Volume :
- 15
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- World journal of gastrointestinal surgery
- Publication Type :
- Academic Journal
- Accession number :
- 36741067
- Full Text :
- https://doi.org/10.4240/wjgs.v15.i1.60