E236: National Trends in Robotic Pancreaticoduodenectomy – A national database analysis

ePoster Abstract Author(s)

Imad Radi, MD

PGY2 General Surgery resident
Medical College of Georgia
augusta, Georgia, United States

Submitter(s)

Imad Radi, MD

PGY2 General Surgery resident
Medical College of Georgia
augusta, Georgia, United States

Author(s)

Imad Radi, MD

PGY2 General Surgery resident
Medical College of Georgia
augusta, Georgia, United States
MN

Mohamed Nofal, MD

Postdoc Research fellow
Medical College of Georgia, United States
MS

Muhannad Sharara, MD

Research Associate
Medical College of Georgia, Georgia, United States
Ankit Dhiman, MBBS

General Surgery Resident
Department of Surgery, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA
Augusta, Georgia, United States
AK

Aghapy Kirolos, n/a

Postdoc Research fellow
Medical College of Georgia, United States
DY

Danny Yakoub, MD, PhD, FACS

Chief of Surgical Oncology
Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

Introduction: Robotic pancreatic surgery is expanding across the country. We investigated 11 years of national trends and surgical outcomes for robotic pancreaticoduodenectomy (RPD) for primary pancreatic tumors.

Methods: The National Cancer Database (NCDB) was queried for RPD performed during five time periods: 2010-2012, 2013-2014, 2015-2016, 2017-2018, 2019-2020. These time periods were compared for patient factors, center factors, and short-term surgical outcomes.

Results: Robotic Whipple numbers increased during the study period (153 in 2010-2012 to 822 in 2019-2020). Patient age, race and disease histology has remained unchanged throughout the years. However, the proportion of cases performed on patients with higher Charlson-Deyo Score and clinical stage III has increased (0.7% to 6.3%, p=0.011 and 0.7% to 23%, p=0.001 respectively). From 2010 to 2020, the proportion of RPDs performed at academic centers decreased (81% to 57%, p=0.001). There was a significant decrease in the total proportion of RPD in the Middle Atlantic states (53% to 19%) with an increase in proportion mostly noted in the South Atlantic region (12% to 34%) and in the East North Central region (9% to 17%). In terms of surgical outcomes and throughout the studied period, improvements in 90-days mortality (6.5% to 2%, p = 0.043), length of stay (10 to 7.8, p< 0.001) and lymph node harvest (17.6 to 18.5, p< 0.001) were observed. There was a trend in reduced conversion to open rates from 18% to 12% without reaching significance (p=0.073). There was no noted difference in negative margin resections, or readmissions.

Conclusions: Robotic pancreaticoduodenectomy surgery is expanding nationwide. It is increasingly being offered to sicker patients with more advanced stages, while preserving and improving key surgical outcomes. This data supports the continued safe implementation and proliferation of robotic Whipple surgery.

Learning Objectives:

learn about trends in numbers of robotic pancreaticoduodenectomies accross the country and its geographical distribution
list the patient caracteristics of patients undergoing Robotic Whipples and its trend throughout the past 10 years accross the nation
define the short term surgical outcomes of RPD and its improvement throughout the years