Four-Day Robotic Whipple: Early Discharge after Robotic Pancreatoduodenectomy

Author:

Fong Zhi Ven1,Lwin Thinzar M1,Aliaj Agim1,Wang Jiping1,Clancy Thomas E1

Affiliation:

1. From the Division of Surgical Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA.

Abstract

BACKGROUND: The authors aimed to assess the safety of an enhanced recovery after surgery (ERAS) and early discharge pathway in a robotic pancreatoduodenectomy (PD) program and compared outcomes with an open PD control cohort to identify the synergistic effects of robotic surgery and an ERAS pathway on lengths of stay (LOS). STUDY DESIGN: Consecutive patients undergoing open or robotic PD from a single surgeon between March 2020 and July 2022 were identified. Logistic regression models were used for adjusted analyses of postoperative outcomes. RESULTS: There were 134 consecutive PD patients, of which 40 (30%) were performed robotically. Pancreatic adenocarcinoma was the most common indication in both open (56%) and robotic (55%, p = 0.51) groups, with a similar proportion of them being borderline resectable or locally advanced tumors (78% vs 82% in robotic group, p = 0.82). The LOS was significantly shorter in the robotic PD group (median, 5 [IQR 4 to 7] days) when compared with the open PD group (median, 6 [IQR 5 to 8] days, p < 0.001). LOS of 4 days or fewer were observed in 40% of the robotic PD group compared with only 3% of patients in the open PD group (p < 0.001). There was no difference in the overall readmission rate (10% vs 12% in the robotic PD group, p = 0.61). On multivariable logistic regression, robotic PD was independently associated with higher odds of LOS of 4 days or fewer (odds ratio 22.4, p = 0.001) when compared with open PD. CONCLUSIONS: An ERAS and early discharge pathway could be safely implemented in a robotic PD program. Patients undergoing robotic PD have significantly shorter length of stay without increased complication or readmission rate compared with open PD, with 40% of patients undergoing robotic PD achieving a LOS of 4 days or fewer.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

Cited by 4 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. The role of ERAS in robotic pancreaticoduodenectomy;The Lancet Gastroenterology & Hepatology;2024-07

2. The role of ERAS in robotic pancreaticoduodenectomy – Authors' reply;The Lancet Gastroenterology & Hepatology;2024-07

3. What are the true benefits of robotic pancreaticoduodenectomy for patients with pancreatic cancer?;Expert Review of Gastroenterology & Hepatology;2024-05-03

4. Invited Commentary;Journal of the American College of Surgeons;2023-03-27

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