Robotic vs. laparoscopic distal pancreatectomy: a leap towards superior outcomes?

Robotic distal pancreatectomy (RDP) is one of the latest and most advanced minimally invasive surgical approaches for the treatment of pancreatic body-tail tumors. However, its superiority over laparoscopic distal pancreatectomy (LDP) remains not fully established. Moreover, Textbook Outcome (TO) represents an ideal short-term postoperative outcome. Yet few studies have used it as an endpoint when comparing these two minimally invasive surgical techniques. We retrospectively analyzed data from all consecutive patients who underwent standard minimally invasive distal pancreatectomy (MIDP) at a high-volume pancreatic center between January 2019 and December 2022. Demographic and clinical characteristics, as well as perioperative variables, were compared between the RDP and LDP groups. Additionally, we calculated the rate of TO achievement following MIDP and performed a multivariate logistic regression analysis to determine factors independently associated with TO achievement. A total of 196 patients who underwent standard MIDP were included in the analysis, with 97 in the RDP group and 99 in the LDP group. Compared with LDP, RDP was associated with a shorter operative time (129.48 vs. 177.27 min, P < 0.001) and less intraoperative blood loss (50 vs. 100 mL, P < 0.001). The RDP group exhibited a shorter postoperative hospital stay (10 vs. 11 days, P = 0.031) and a higher TO rate (68.0% vs. 53.5%, P = 0.042), with no statistically significant differences in the incidence of major postoperative complications between the two groups. Overall, 60.7% of patients (119/196) achieved TO. Multivariate logistic regression analysis revealed that advanced age (≥ 75 years) (OR 3.758, 95% CI 1.480–9.546, P = 0.005), being overweight (OR 2.366, 95% CI 1.243–4.502, P = 0.009), and prolonged operative time (> 232 min) (OR 2.554, 95% CI 1.096–5.952, P = 0.030) were independent risk factors for failure to achieve TO after MIDP. RDP has distinct advantages, including shorter operative time, less intraoperative bleeding, shorter postoperative hospital stays, and higher TO rate. For MIDP, advanced age, overweight, and prolonged operative time are associated with TO.