Nationwide Robotic Pancreas Surgery Trends and Pancreatectomy Outcomes in Cases of Adenocarcinoma

Two studies from researchers at UPMC Hillman Cancer Center, led by Amer H. Zureikat, MD, FACS, provide data on national trends in the use of robotic pancreas surgery, and the long-term outcomes comparing robotic versus open pancreatectomy in cases of pancreatic adenocarcinoma.

In the first study¹, Dr. Zureikat and colleagues examined national data to better understand utilization trends for robotic pancreatic surgery and related outcomes for robotic-assisted pancreaticoduodenomectomy and distal pancreatectomy for primary tumors of the pancreas. The study examined data between 2010 and 2016 from the National Cancer Database and looked at long-term volume trends of robotic versus open procedures at high and low-volume centers. The study also compared outcomes measures between robotic and open procedures, including mortality improvements, patient characteristics, negative surgical margins, and the conversion rates from robotic to open surgery. 

Key findings of the analysis showed that the total volume of robotic procedures has steadily increased over time, and more nonacademic or low-volume centers are performing robotic procedures with comparable surgical outcomes compared to their high-volume center colleagues. Also notable was a temporal reduction in 90-day mortality rates of cases of robotic pancreatoduodenectomy from the beginning of the study period in 2010 to the cutoff in 2016. The 90-day mortality rates for these cases decreased from 6.7% to 1.8% over time. These findings bode well for the continued adoption and dissemination of robotic pancreatic surgery and the robustness of training programs for surgeons.

The second study² from Dr. Zureikat and colleagues probed the trends in outcomes in robotic pancreatectomy versus open procedures in cases of pancreatic ductal adenocarcinoma. Data for this study was derived from the National Cancer Database for robotic and open pancreatectomy cases between 2010 and 2016 and included close to 20,000 cases. The primary objective of the investigation was to assess and compare the long-term oncologic outcomes between the two procedural approaches. This is the first study to examine long-term outcomes on a national level between robotic and open procedures.

In this study, Dr. Zureikat and colleagues found no significant difference in median overall survival between cases of pancreatoduodenectomy performed robotically or in an open approach. However, for cases of distal pancreatectomy, long-term survival rates favored those cases performed robotically. The median overall survival for robotic cases of distal pancreatectomy was 35.3 months, whereas for open procedures, the median survival time was 24.9 months. Other notable findings include reduced rates of 30- and 90-day mortality for robotic distal pancreatectomy versus open procedures and a marked decrease in the risk of a prolonged hospital length of stay for robotic cases versus open procedures. Robotic pancreatectomy saw a 20% decrease in risk of prolonged length of stay compared to open procedures, while robotic distal pancreatectomy cases had a 50% risk reduction. 

More About Dr. Zureikat

Amer H. Zureikat, MD, FACS, is vice-chair of surgery for surgical oncology in the Department of Surgery at UPMC, chief of surgical oncology at UPMC Hillman Cancer Center, and UPMC Chair of Clinical Surgery. He is the division chief for gastrointestinal surgical oncology in the Department of Surgery at UPMC and an associate professor of surgery at the University of Pittsburgh School of Medicine. Dr. Zureikat specializes in cancers and diseases of the pancreas, stomach, liver, and duodenum, and is an expert in robotic pancreatic surgery. His clinical and academic interests include the multimodality treatment of pancreatic cancer and the comparative effectiveness of open and robotic approaches to gastrointestinal cancers in general, and pancreatic cancer in particular.

References

1. Hoehn RS, Nassour I, Adam MA, Winters S, Paniccia A, Zureikat AH. National Trends in Robotic Pancreas Surgery. J Gastrointest Surg. 2020 Apr 20;  doi: 10.1007/s11605-020-04591-w. Epub ahead of print.

2. Nassour I, Winters SB, Hoehn R, Tohme S, Adam MA, Bartlett DL, Lee KK, Paniccia A, Zureikat AH. Long-term Oncologic Outcomes of Robotic and Open Pancreatectomy in a National Cohort of Pancreatic Adenocarcinoma. J Surg Oncol. 2020; 122: 234-232.

Further Reading on Robotic Pancreatic Surgery Research From UPMC Hillman Cancer Center Faculty

Wilson GC, Zeh HJ 3rd, Zureikat AH. How I Do It: Robotic Pancreaticoduodenectomy. J Gastrointest Surg. 2019 Aug; 23(8): 1661-1671.

Beane JD, Zenati M, Hamad A, Hogg ME, Zeh HJ 3rd, Zureikat AH. Robotic Pancreato-duodenectomy With Vascular Resection: Outcomes and Learning Curve. Surgery. 2019 Jul; 166(1): 8-14.

Kowalsky SJ, Zenati MS, Steve J, Esper SA, Lee KK, Hogg ME, Zeh HJ 3rd, Zureikat AH. A Combination of Robotic Approach and ERAS Pathway Optimizes Outcomes and Cost for Pancreatoduodenectomy. Ann Surg. 2019 Jun; 269(6): 1138-1145.

Varley PR, Zenati MS, Klobuka A, Tobler J, Hamad A, Hogg ME, Zeh HJ 3rd, Borhani AA, Zureikat AH. Does Robotic Pancreaticoduodenectomy Improve Outcomes in Patients With High Risk Morphometric Features Compared to the Open Approach. HPB (Oxford). 2019 Jun; 21(6): 695-701.