title: Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study.
abstract: BACKGROUND
  Robot-assisted laparoscopic pancreaticoduodenectomy is a novel minimally invasive surgery technique, and its effectiveness and safety remain unknown in patients with borderline malignant or malignant diseases. This study aimed to prospectively evaluate the effectiveness and safety of RLPD versus open PD (OPD).
  
  
  METHODS
  Between January 2010 and December 2013, 180 eligible patients were prospectively hospitalized for elective RLPD (n = 60) or OPD (n = 120). They were matched for tumor location, tumor type, tumor size, ASA classification, age, and sex. The main outcome measures included demographics, intraoperative variables, morbidity, postoperative recovery, and mid-term evaluation.
  
  
  RESULTS
  Over the study period, the RLPD group had a significantly longer but decreasing operative time (median 410 vs. 323 min; P < 0.001), less blood loss (median 400 vs. 500 mL; P = 0.005), better nutritional status recovery, expedited off-bed return to activity (3.2 vs. 4.8 d; P < 0.001), faster resumption of bowel movement (3.6 vs. 5.2 d; P < 0.001), and shorter hospital stay (20 vs. 25 d; P = 0.002) compared to the OPD group. The two groups had similar surgical morbidities and mortality as well as R0 resection rate and number of lymph nodes resected. Among patients with pancreatic adenocarcinoma, the two groups had similar overall and disease-free survival (ACTRN12614000299606).
  
  
  CONCLUSIONS
  This first largest, prospective matched study demonstrated that for treating selected borderline and malignant pathologies, RLPD was associated with a significant learning curve effect and expedited postoperative recovery, but had a surgical and oncological safety profile similar to OPD.
authors.affiliation: Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. wawljwalj@163.com.|Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China. wawljwalj@163.com.
authors.forename: Shi
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.|Department of Hepatobiliary Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Jiang-Zhi
authors.initials: JZ
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. zhanxi80@hotmail.com.|Department of General Surgery, Research Institute of Pancreatic Disease and Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. zhanxi80@hotmail.com.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhan
authors.affiliation: Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xia-Xing
authors.initials: XX
authors.lastname: Deng
authors.affiliation: Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Bai-Yong
authors.initials: BY
authors.lastname: Shen
authors.affiliation: Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. chhpeng@yeah.net.|Department of General Surgery, Research Institute of Pancreatic Disease and Shanghai Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. chhpeng@yeah.net.
authors.forename: Cheng-Hong
authors.initials: CH
authors.lastname: Peng
authors.affiliation: Department of General Surgery, Research Institute of Pancreatic Disease, Institute of Digestive Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Li
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Learning curve; Minimally invasiveness; Pancreaticoduodenectomy; Prospective study; Robot-assisted laparoscopy; Safety profile