Robotic surgery for small bowel neuroendocrine tumors is associated with greater nodal harvest compared to laparoscopic surgery

INTRODUCTION: Robotic surgery has been increasingly used for the treatment of small bowel neuroendocrine tumors and offers potential advantages in visualization of nodal disease and mesenteric dissection compared to laparoscopy; however, oncologic outcomes of robotic surgery have not yet been characterized. We sought to compare lymph node harvest of robotic surgery versus laparoscopy and associated long-term survival for small bowel neuroendocrine tumors using a large national cohort. METHODS: The National Cancer Database was queried for patients who underwent robotic surgery/laparoscopy for stage I-III small bowel neuroendocrine tumors from 2015 to 2022. Kaplan-Meier and multivariable Cox proportional hazards analyses were used to assess overall survival. Multivariable logistic regression was used to identify factors associated with adequate lymph node harvest (defined as ≥9 nodes resected). RESULTS: Of 5,432 eligible patients, 1,066 (19.6%) underwent robotic surgery. After propensity-matching, robotic surgery was associated with greater lymph node harvest versus laparoscopy (median 17 vs 14 nodes, P < .001) and improvement in select short-term perioperative outcomes. On Cox proportional hazards analysis, the threshold lymph node harvest of ≥9 nodes was associated with the greatest 5-year mortality reduction (adjusted hazard ratio: 0.696, P = .002). On multivariable logistic regression, undergoing robotic surgery was associated with increased likelihood of achieving lymph node harvest of ≥9, even when controlling for tumor characteristics/location (adjusted odds ratio: 2.09, P < .001). CONCLUSION: Robotic surgery was associated with greater lymph node harvest in patients with stage I-III small bowel neuroendocrine tumors compared to laparoscopy. Patients with ≥9 nodes harvested exhibited improved overall survival , and robotic surgery was significantly associated with achievement of this threshold. Robotic surgery may offer technical and oncologic advantages over laparoscopy in appropriately selected patients with resectable small bowel neuroendocrine tumors.