Robotic Versus Open and Laparoscopic Pancreaticoduodenectomy: A Nationwide Matched Study in Japan

To evaluate real-world clinical outcomes of robotic pancreaticoduodenectomy (PD) versus open and laparoscopic PD in a nationwide cohort.

While robotic PD has gained popularity as a minimally invasive approach to pancreatic surgery, its clinical effectiveness remains uncertain owing to the limited generalizability of existing evidence.

Data from the Japanese National Clinical Database, which captures over 95% of surgical procedures conducted nationwide, were analyzed. Patients who underwent PD between January 2019 and December 2023 were included. Propensity score matching was used to compare robotic PD with open and laparoscopic PD.

Among 46,166 eligible PD cases, 1,371 were robotic. To ensure consistent surgical proficiency, the analysis included cases performed at institutions conducting ≥20 PDs annually (n=23,613). Following 1:1 matching, 1,248 robotic-open and 1,066 robotic-laparoscopic pairs were identified. Robotic PD was associated with a lower severe complication incidence than that with open (22.2% vs. 25.9%; odds ratio, 0.82; 95% confidence interval, 0.68-0.98; P=0.031) and laparoscopic PD (23.0% vs. 27.6%; odds ratio, 0.78; 95% confidence interval, 0.64-0.95; P=0.015). Robotic PD was also associated with a lower incidence of pancreatic fistula and shorter hospital stay, despite extended operative time. An increased incidence of deep venous thrombosis was observed in the robotic PD group.

In this nationwide, Japanese credentialed setting, robotic PD was associated with improved short‑term outcomes compared with those of open and laparoscopic PD. As PD outcomes are influenced by surgeon/institutional experience and case complexity (tumor factors), these aspects should be carefully considered when selecting robotic PD.