26 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x4 Auteurs N. de Graaf, M. J.W. Zwart, J. van Hilst, O. R. Busch, F. Daams, S. van Dieren, S. Festen, D. J. Lips, M. D.P. Luyer, J.S.D. Mieog, I. Quintus Molenaar*, B. Groot Koerkamp*, M. G. Besselink* for the Dutch Pancreatic Cancer Group Abstract titel First experience of robotic versus open pancreatoduodenectomy: a nationwide propensity-score matched analysis Background While robotic pancreatoduodenectomy (RPD) has shown promising outcomes in experienced high-volume centers, it is unclear whether implementation on a nationwide scale is safe and beneficial. This study compared the outcomes of early experience with RPD versus conventional open pancreatoduodenectomy (OPD) in the Netherlands, focusing on patient safety. Methods A nationwide retrospective cohort study of all consecutive patients undergoing RPD and OPD registered in the mandatory Dutch Pancreatic Cancer Audit (18 centers, 2014-2021), starting from the first RPD procedures per center. Main endpoints were major complications (Clavien-Dindo ≥3) and in-hospital/30-day mortality. Propensity-score matching (1:1) was used to minimize selection bias. Sensitivity analyses on learning curve, volume, and indications were performed. Results Overall, 701 patients after RPD and 4447 after OPD were included. Among the eight centers that started RPD during the inclusion period, the median RPD experience was 86 (range 48-149), with a 7.3% conversion rate. After matching (698 RPD vs. 698 OPD controls), no significant differences were found in major complications (40.3% vs. 36.2%, P=0.186), in-hospital/30-day mortality (4.0% vs. 3.1%, P=0.326), postoperative pancreatic fistula grade B/C (24.9% vs. 23.5%, P=0.578) and post-pancreatectomy hemorrhage grade B/C (12.5% vs 9.6%, P=0.111). RPD was associated with longer operative time (359 vs. 301 min, P<0.001), less intraoperative blood loss (200 vs. 500 mL, P<0.001), fewer wound infections (7.4% vs. 12.2%, P=0.008), and shorter hospital stay (11 vs. 12 days, P<0.001) than OPD. In patients with pancreatic cancer (N=453), no difference was found in R0-resection rate (60.1% vs. 54.6%, P=0.106). Centers performing ≥20 RPDs annually had lower mortality (2.9% vs. 7.3%, P=0.009) and conversion rates (6.3% vs. 11.2%, P=0.032).
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