HPB
non-CME
Pamela W. Lu, MD, MPH (she/her/hers)
Clinical fellow
MD Anderson Cancer Center, Texas, United States
Disclosure(s): No financial relationships to disclose
Pamela W. Lu, MD, MPH (she/her/hers)
Clinical fellow
MD Anderson Cancer Center, Texas, United States
Disclosure(s): No financial relationships to disclose
Heather G. Lyu, MD, MBI
Clinical fellow
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
Jess Maxwell, MD, MBA (she/her/hers)
Assistant Professor
MD Anderson Cancer Center, United States
Disclosure(s): Ipsen: Advisor (Terminated, October 25, 2021); TerSera Therapeutics: Advisor (Terminated, August 20, 2022)
Laura R. Prakash, MD
Clinical Research Scientist
MD Anderson Cancer Center, United States
Disclosure information not submitted.
Timothy E. Newhook, MD, FACS
Assistant Professor
MD Anderson Cancer Center
Houston, Texas, United States
Disclosure(s): No financial relationships to disclose
Rebecca A. Snyder, MD, MPH (she/her/hers)
Associate Professor of Surgery
UT MD Anderson Cancer Center
Houston, Texas, United States
Disclosure information not submitted.
Hop S. Tran Cao, MD (he/him/his)
Associate Professor of Surgery
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Disclosure(s): Intuitive Surgical: Research Grant (Ongoing)
Michael P. Kim, MD
Assistant Professor
MD Anderson Cancer Center, United States
Disclosure information not submitted.
Ching-Wei D. Tzeng, MD (he/him/his)
Associate Professor
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Disclosure(s): Panther: Consultant (Ongoing)
Jeffrey E. Lee, MD
Professor
MD Anderson Cancer Center, United States
Disclosure information not submitted.
Matthew HG Katz, MD (he/him/his)
Professor & Chair
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Disclosure(s): No financial relationships to disclose
Naruhiko Ikoma, MD, MS
Assistant Professor
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Disclosure information not submitted.
Timely return to intended oncologic therapy (RIOT) after surgery has been shown to impact survival in patients with pancreatic ductal adenocarcinoma (PDAC), but the effect of surgical approach on RIOT after pancreatectomy has been scarcely reported.
Methods:
Patients who underwent distal pancreatectomy (DP) or pancreaticoduodenectomy (PD) for PDAC between January 2018 and December 2021 were identified. Patients requiring vascular resection or had other organ invasion were excluded. Patients who had robotic surgery were exact matched 1:2 without replacement on type of pancreatectomy (PD or DP) with those who had open surgery. Patient characteristics, perioperative and postoperative data were collected from a prospectively maintained institutional database. Early RIOT was defined as planned initiation of adjuvant chemotherapy within 8 weeks of surgery. Patients who declined recommended adjuvant therapy or for whom adjuvant therapy was not recommended were excluded from RIOT analysis. Multivariable logistic regression was used to evaluate the effect of surgical approach on early RIOT.
Results:
Thirty patients who underwent robotic surgery were matched to 60 patients who underwent open surgery. There were no significant differences between groups in gender, age, race/ethnicity, smoking status, BMI, ASA status, receipt of neoadjuvant chemotherapy or radiation (all p >0.05). Across both groups, 43% of patients underwent DP and 57% of patients underwent PD. There were no significant differences in the rates of any postoperative complications (open 57%, robotic 47%, p=0.38) or 90-day readmissions (open 28%, robotic 20%, p=0.45). Patients who underwent robotic pancreatectomy had significantly longer median operative time (433 min, IQR 325-533 min, vs. 366.5 min, IQR 268-411 min, p=0.036), lower estimated blood loss (100 mL, IQR 50-150 mL, vs. 200 mL, IQR 150-250 mL, p< 0.001), and shorter length of stay (4 days, IQR 3-4 days, vs. 5 days, IQR 4-6 days, p< 0.001). Recommended RIOT was achieved (at any time) in 97% of patients in the robotic cohort and 88% of the open cohort (p=0.62). Early RIOT occurred in significantly more patients who had robotic resection compared to open resection (72% vs. 47%, p=0.036). In multivariable analysis, robotic approach was a significant predictor of early RIOT (OR 2.93, 95% CI 1.08-7.98, p=0.036).
Conclusions:
In this matched cohort, patients who underwent robotic pancreatectomy for PDAC had significantly higher odds of early RIOT compared to those who had open resection.