Evaluation of feasibility and clinical outcomes of robot-assisted pancreaticoduodenectomy after neoadjuvant treatment for patients with advanced pancreatic ductal adenocarcinoma: a retrospective propensity score-matched cohort study

With neoadjuvant treatment (NAT) broadening the surgical indication for advanced pancreatic cancer, the growing use of robotic platforms in pancreaticoduodenectomy (PD) necessitates the evaluation of its feasibility in advanced pancreatic cancer patients who have undergone NAT. We compared clinicopathological outcomes of advanced pancreatic cancer patients who received either robot-assisted or open PD after NAT at a tertiary hospital from 2015 to 2023. Propensity score matching was performed based on age, sex, and TNM staging. Among 223 patients who received conversion surgery after NAT, 42 open PD and 14 robot-assisted PD patients were matched in a 3:1 ratio. There was a trend of shorter hospital stays (11.4 days vs. 9.8 days, P = 0.218) and less severe postoperative complications (21.4% vs. 7.1%; P = 0.227) in the robot-assisted PD group. Lymph node (LN) yield, LN metastasis rate, and R0 resection rates were similar between the 2 groups. The overall (OS) and disease-free survival (DFS) rates between the 2 groups were comparable (5-year OS rate: 55.7% vs. 72.7%, P = 0.264; 5-year DFS rate: 54.4% vs. 58.4%, P = 0.759). Robot-assisted PD offers comparable short-term and long-term outcomes to open PD, even in patients undergoing conversion surgery after NAT.