Robotic vs. Laparoscopic Distal Pancreatectomy: A Leap Towards Superior Outcomes?

Background Robotic distal pancreatectomy (RDP) is the latest and most advanced minimally invasive method for treating pancreatic body-tail tumors. However, its superiority over laparoscopic distal pancreatectomy (LDP) has yet to be clearly established. And there are currently no studies that have compared the Textbook outcomes (TO) rates between the two techniques. Methods We retrospectively analyzed data from consecutive patients who underwent standard minimally invasive distal pancreatectomy (MIDP) in a high-volume pancreatic center from January 2019 to December 2022. The characteristics and perioperative variables of RDP and LDP patients were compared. Meanwhile we calculated the proportion of patients who achieved TO after MIDP and performed a multivariate logistic regression to identify factors independently associated with achieving TO. Results The analysis included 196 patients who underwent standard MIDP, including 96 patients who underwent RDP and 99 LDP. RDP was associated with shorter operation time (129.48 min vs. 177.27 min, p < 0.001) and lower bleeding (50 mL vs. 100 mL, p < 0.001). The RDP group had shorter postoperative hospital stay (10 d vs. 11 d, p = 0.031) and higher TO rate (68.0% vs. 53.5%, p = 0.042), with no significant differences in major postoperative complications. Among all patients, 60.7% (119/196) achieved TO. Multivariate analysis demonstrated that older (≥ 75 years) (OR 3.758, 95% CI 1.480–9.546, p = 0.005), overweight (OR 2.366, 95% CI 1.243–4.502, p = 0.009) and operation time > 232 min (OR 2.554, 95%CI 1.096–5.952, p = 0.030) were independent risk factors for achieving TO after MIDP. Conclusion RDP has the advantages of shorter operative time and less bleeding, as well as a shorter length of postoperative hospital stay and higher TO rate. TO is associated with age, overweight and operative time in MIDP.