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Postoperative outcomes and costs of laparoscopic versus robotic distal pancreatectomy: a propensity-matched analysis

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Abstract

Background

Minimally invasive distal pancreatectomy (MIDP) has established advantages over the open approach. The costs associated with robotic DP (RDP) versus laparoscopic DP (LDP) make the robotic approach controversial. We sought to compare outcomes and cost of LDP and RDP using propensity matching analysis at our institution.

Methods

Patients undergoing LDP or RDP between 2000 and 2021 were retrospectively identified. Patients were optimally matched using age, gender, American Society of Anesthesiologists status, body mass index, and tumor size. Between-group differences were analyzed using the Wilcoxon signed-rank test for continuous data, and the McNemar’s test for categorical data. Outcomes included operative duration, conversion to open surgery, postoperative length of stay, pancreatic fistula rate, pseudocyst requiring intervention, and costs.

Results

298 patients underwent MIDP, 180 (60%) were laparoscopic and 118 (40%) were robotic. All RDPs were matched 1:1 to a laparoscopic case with absolute standardized mean differences for all matching covariates below 0.10, except for tumor type (0.16). RDP had longer operative times (268 vs 178 min, p < 0.01), shorter length of stay (2 vs 4 days, p < 0.01), fewer biochemical pancreatic leaks (11.9% vs 34.7%, p < 0.01), and fewer interventional radiological drainage (0% vs 5.9%, p = 0.01). The number of pancreatic fistulas (11.9% vs 5.1%, p = 0.12), collections requiring antibiotics or intervention (11.9% vs 5.1%, p = 0.12), and conversion rates (3.4% vs 5.1%, p = 0.72) were comparable between the two groups. The total direct index admission costs for RDP were 1.01 times higher than for LDP for FY16-19 (p = 0.372), and 1.33 times higher for FY20-22 (p = 0.031).

Conclusions

Although RDP required longer operative times than LDP, postoperative stays were shorter. The procedure cost of RDP was modestly more expensive than LDP, though this was partially offset by reduced hospital stay and reintervention rate.

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Data availability

Data are available upon reasonable request from the corresponding author.

Abbreviations

MIDP:

Minimally invasive distal pancreatectomy

RDP:

Robotic distal pancreatectomy

LDP:

Laparoscopic distal pancreatectomy

STROBE:

Strengthening the reporting of observational studies in epidemiology

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

EBL:

Estimated blood loss

LOS:

Length of hospital stay

PDAC:

Pancreatic ductal adenocarcinoma

WHO:

World Health Organization

OR:

Operative Room

IR:

Interventional radiology

ISGPF:

International Study Group of Pancreatic Fistula

SD:

Standard deviation

SMD:

Standardized mean differences

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Funding

This study is investigator-initiated (Stanford University), there was no funding for this research.

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Authors and Affiliations

  1. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Hester C. Timmerhuis, Christopher W. Jensen, Rejoice F. Ngongoni, Jonathan C. DeLong, Monica M. Dua, Jeffrey A. Norton, George A. Poultsides, Patrick J. Worth & Brendan C. Visser

  2. Stanford Prevention Research Center and Departments of Statistics and Health Research and Policy, Stanford University, Stanford, CA, USA

    Michael Baiocchi

  3. Department of Quality, Stanford University School of Medicine, Stanford, CA, USA

    Rika Ohkuma

  4. Department of Surgery, Stanford Health Care & Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Brendan C. Visser

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Contributions

HCT and CWJ collected and entered all data. HCT, CWJ, and RFN verified all entered data. HCT performed the statistical analysis. MB verified the performed statistical analysis. HCT and RO performed the financial analysis. HCT drafted the manuscript. CWJ, RFN, MB, JDL, RO, MD, JN, GP, PW, and BV co-authored the writing of the manuscript. All authors critically assessed the study design, included patients in the study, edited the manuscript, and read and approved the final manuscript.

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Correspondence to Brendan C. Visser.

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Disclosures

Drs. Hester C. Timmerhuis, Drs. Christopher W. Jensen, Drs. Rejoice F. Ngongoni, Drs. Michael Baiocchi, Drs. Jonathan C. DeLong, Drs. Rika Ohkuma, Drs. Monica M. Dua, Drs. Jeffrey A. Norton, Drs. George A. Poultsides, Drs. Patrick J. Worth, and prof. Drs. Brendan C. Visser have no conflicts of interest or financial ties to disclose.

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Timmerhuis, H.C., Jensen, C.W., Ngongoni, R.F. et al. Postoperative outcomes and costs of laparoscopic versus robotic distal pancreatectomy: a propensity-matched analysis. Surg Endosc 38, 2095–2105 (2024). https://doi.org/10.1007/s00464-024-10728-8

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