National utilization and outcomes of robotic pancreatoduodenectomy.

BACKGROUND

Minimally-invasive approaches to pancreatic surgery are increasingly utilized. We aimed to evaluate the implementation of robotic pancreatoduodenectomy (RPD) across the United States.

METHODS

The National Cancer Database was queried for all patients undergoing pancreatoduodenectomy (PD) for pancreatic cancer in the United States between 2010 and 2020. The primary outcome was utlization of robotic PD. Secondary outcomes included perioperative outcomes following PD.

RESULTS

There were 48,781 patients who underwent PD with 78.0 % and 5.2 % performed by an open and robotic approach, respectively. Utilization of RPD increased from 1.1 % to 10.3 % between 2010 and 2020 (p < 0.001). Robotic converted to open PD decreased from 22.2 % to 11.1 % over the study period (p = 0.006). Patients undergoing open or RPD had similar R0 resection, 30-day unplanned readmission, and 90-day mortality. The 10 highest volume centers for RPD performed 41.8 % of all RPD and had lower rates of conversion to open, post-operative length of stay, and a higher number of lymph nodes examined compared with other centers performing RPD (all p < 0.001).

CONCLUSION

Robotic PD is increasingly utilized in the United States but still represents a small fraction of patients undergoing PD. Given improved outcomes observed in high-volume centers, deliberate initiatives to expand RPD programs while ensuring continued centralization are important.