Robotic pancreatectomy for pancreatic adenocarcinoma: evolving trends in patient selection and practice patterns across a decade.

[BACKGROUND] Robotic surgery has been developed as an additional minimally invasive approach to pancreatectomy. We assessed case selection and perioperative outcomes in patients undergoing robotic pancreatectomy for pancreatic adenocarcinoma over time.

[METHODS] The National Cancer Database (2010-2019) was queried to identify all pancreatic adenocarcinoma patients that underwent robotic pancreatoduodenectomy (RPD) or distal pancreatectomy (RDP). Two periods were established: Early cohort (2010-2014) and Modern cohort (2015-2019).

[RESULTS] Of 2245 patients who underwent RPD or RDP, 78.4 % of RPD and 77.6 % of RDP were in the Modern cohort. Robotic approach increased from 2010 to 2019 (RPD: 1.1 %-7.5 %, RDP: 2.2 %-19.4 %; both p < 0.001). Compared to Early, Modern RPD patients were more likely to have non-private insurance (68.5 % vs. 58.7 %), and both RPD (47.0 % vs. 23.4 %) and RDP (47.3 % vs. 32.1 %) patients were more frequently treated in non-academic hospitals (all p < 0.01). Shorter LOS was noted in the Modern RPD (6 vs. 8 days) and RDP cohorts (5 vs. 6 days, both p < 0.001), without differences in readmission/mortality. In RPD and RDP, no differences in overall survival were observed between the eras.

[CONCLUSIONS] Robotic pancreatectomy for pancreatic adenocarcinoma has increased over time with greater inclusion of patients and hospital types while outcomes have remained similar.