Outcomes After Robot-Assisted Pancreaticoduodenectomy for Periampullary Lesions

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Abstract
There are many theoretical advantages that a minimally invasive approach to the pancreaticoduodenectomy might offer patients with benign and malignant disease of the head of the pancreas over traditional open techniques, including improved recovery time, decreased hospital stay, and earlier initiation of and higher rate of completion of adjuvant therapy. The goal of this study was to assess the oncologic and safety outcomes after a robot-assisted approach to pancreaticoduodenectomy. Retrospective review of a prospectively acquired database of robot-assisted pancreaticoduodenectomy (RAPD) for periampullary lesions between October 2008 and December 2010. Fifty patients underwent attempted RAPD. Conversion to open procedure was required in eight patients (16%). At intention-to-treat analysis, pancreatic fistula as defined by the International Study Group of Pancreatic Surgery occurred in 10 patients (20%). Most patients experienced either no (21, 42%) postoperative complications or minor Clavien I/II events (13, 26%). Major morbidity (Clavien III/IV) occurred in 15 patients (30%). The margin-negative resection rate was 89%, and the median number of lymph nodes collected was 18. Fifteen patients met the eligibility criteria for adjuvant chemotherapy after surgery. Eleven (73.3%) of 15 eligible patients were treated with adjuvant therapy at a mean of 11.5 weeks after surgery. RAPD can be performed with safety and oncologic outcomes comparable to open or laparoscopic approaches. Results of this early series suggest that the robot-assisted approach holds promise. Larger, more mature multi-institutional cohorts will be needed to explore potential benefits over open and laparoscopic techniques.