Robotic versus laparoscopic pancreaticoduodenectomy: a propensity score matching analysis of Taiwan’s national health insurance database

Pancreaticoduodenectomy (PD) is the gold standard treatment for localized pancreatic head tumors and has a high surgical morbidity rate. In recent years, minimally invasive approaches, such as laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), have gained prominence. However, it remains controversial whether RPD has better clinical outcomes than LPD does. This nationwide cohort study used data from Taiwan's National Health Insurance Research Database to investigate patients who underwent RPD or LPD between 2017 and 2021. Full propensity score matching was used to estimate the average treatment effect between the two groups. The primary outcomes included reoperation, optimal outcomes, length of intensive care unit (ICU) stay, and hospital mortality. The secondary outcomes included length of stay (LOS) and 14-day readmission. In total, 854 patients were included in the study, 590 of whom underwent RPD and 264 of whom underwent LPD. After propensity score matching, RPD was significantly associated with a shorter ICU stay (mean difference [MD], -1 d, 95% confidence interval [CI]: -1.8 to -0.2 day, p = 0.020), lower reoperation rate (risk difference [RD] -6.2%, 95% CI: -9.3% to -3.1%, p < 0.001), and shorter LOS (MD, -3.5 d, 95% confidence interval [CI]: -5.5 to -1.6 day, p < 0.001) than was LPD. There were no statistically significant differences in optimal outcomes, 14-day readmission rates, or hospital mortality. Moderation analysis revealed that high-volume centers had higher rates of optimal outcomes and shorter hospital stays compared to low-volume centers. Our results suggest that RPD has better postoperative outcomes than does LPD. Additionally, high-volume centers have better clinical outcomes than low-volume centers do.