LAUSR

OBJECTIVE To compare the rate of postoperative 30-day complications between laparoscopic and robotic pancreaticoduodenectomy. SUMMARY BACKGROUND DATA Previous studies suggest that minimally invasive pancreaticoduodenectomy (MI-PD) - either laparoscopic (LPD) or robotic (RPD) - is non-inferior to open PD in terms of operative outcomes. However, a direct comparison of the two minimally invasive approaches has not been rigorously performed. METHODS Patients who underwent MI-PD were abstracted from the 2014-2019 pancreas-targeted ACS NSQIP dataset. Optimal outcome was defined as absence of postoperative mortality, serious complication, percutaneous drainage, reoperation, and prolonged length of stay (75th percentile, 11▒d) with no readmission. Multivariable logistic regression models were used to compare optimal outcome of RPD and LPD. RESULTS 1,540 MI-PDs were identified between 2014-2019, of which 885 (57%) were RPD and 655 (43%) were LPD. The rate of RPD cases/year significantly increased from 2.4% to 8.4% (P=0.008) from 2014-2019, while LPD remained unchanged. Similarly, the rate of optimal outcome for RPD increased during the study period from 48.2% to 57.8% (P<0.001) but significantly decreased for LPD (53.5% to 44.9%, P<0.001). During 2018-2019, RPD outcomes surpassed LPD for any complication (OR 0.58, P=0.004), serious complications (OR 0.61, P=0.011), and optimal outcome (OR 1.78, P=0.001). CONCLUSIONS RPD adoption increased compared to LPD and was associated with decreased overall complications, serious complications, and increased optimal outcome compared to LPD in 2018-2019.