title: A Multi-institutional Comparison of Perioperative Outcomes of Robotic and Open Pancreaticoduodenectomy.
abstract: OBJECTIVE
  Limited data exist comparing robotic and open approaches to pancreaticoduodenectomy (PD). We performed a multicenter comparison of perioperative outcomes of robotic PD (RPD) and open PD (OPD).
  
  
  METHODS
  Perioperative data for patients who underwent postlearning curve PD at 8 centers (8/2011-1/2015) were assessed. Univariate analyses of clinicopathologic and treatment factors were performed, and multivariable models were constructed to determine associations of operative approach (RPD or OPD) with perioperative outcomes.
  
  
  RESULTS
  Of the 1028 patients, 211 (20.5%) underwent RPD (4.7% conversions) and 817 (79.5%) underwent OPD. As compared with OPD, RPD patients had higher body mass index, rates of prior abdominal surgery, and softer pancreatic remnants, whereas OPD patients had a higher percentage of pancreatic ductal adenocarcinoma cases, and greater proportion of nondilated (<3 mm) pancreatic ducts. On multivariable analysis, as compared with OPD, RPD was associated with longer operative times [mean difference = 75.4 minutes, 95% confidence interval (CI) 17.5-133.3, P = 0.01], reduced blood loss (mean difference = -181 mL, 95% CI -355-(-7.7), P = 0.04) and reductions in major complications (odds ratio = 0.64, 95% CI 0.47-0.85, P = 0.003). No associations were demonstrated between operative approach and 90-day mortality, clinically relevant postoperative pancreatic fistula and wound infection, length of stay, or 90-day readmission. In the subset of 522 (51%) pancreatic ductal adenocarcinomas, operative approach was not a significant independent predictor of margin status or suboptimal lymphadenectomy (<12 lymph nodes harvested).
  
  
  CONCLUSIONS
  Postlearning curve RPD can be performed with similar perioperative outcomes achieved with OPD. Further studies of cost, quality of life, and long-term oncologic outcomes are needed.
authors.affiliation: *Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA †Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute ‡Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA §Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison ¶Department of Surgery, University of Cincinnati, Cincinnati ||Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH **Department of Surgery, NorthShore University Health System, Evanston ††Department of Surgery, Northwestern Memorial Hospital, Chicago, IL ‡‡Department of Surgery, University of North Carolina, Chapel Hill.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Postlewait
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gillespie
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.forename: Mazen
authors.initials: M
authors.lastname: Zenati
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.forename: Brent
authors.initials: B
authors.lastname: Xia
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steve
authors.forename: Trang K
authors.initials: TK
authors.lastname: Nguyen
authors.forename: Hari B
authors.initials: HB
authors.lastname: Keshava
authors.forename: Sricharan
authors.initials: S
authors.lastname: Chalikonda
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Stocker
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lumpkin
authors.forename: Hong J
authors.initials: HJ
authors.lastname: Kim
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D055815:Young Adult