Transitioning from open to minimally invasive pancreaticoduodenectomy: the learning curve factor in an academic centre

Background: Pancreatic surgery has been known to have substantial morbidity and mortality rates. Minimally invasive surgery has been shown to decrease morbidity and recovery time, which in the context of cancer, will eventually translate into a larger number of patients who will recover faster and be ready to get adjuvant systemic treatment. Methods: We compared 3 periods of time when we transitioned from a hybrid laparoscopic, a laparoscopic/robotic, and finally a fully robotic-assisted pancreaticoduodenectomy approach. We compared open to minimally invasive approaches in patients undergoing pancreaticoduodenectomy at our institution from September 2009 to December 2021, regardless of the diagnosis. Demographic, operative, and oncologic data were collected to compare outcomes. Results: A total of 161 patients were included in our analysis: 45 open, 116 minimally invasive (either hybrid laparoscopic, laparoscopic/robotic or fully robotic) There were no differences in patient demographics, comorbidities, or surgical indications. The minimally invasive group (hybrid/ laparoscopic/robotic) had lower intraoperative blood loss, comparable length of hospital stay and a comparable percentage of complications than the open group. Continuous improvement in operative times was observed over the course of the experience as well as fewer conversion rates, which reached their lowest level in the fully robotic era (15%). There were no differences in pancreatic fistula rate. Conclusion: Regarding systemic chemotherapy, more patients undergoing minimally invasive resection get adjuvant treatment than patients undergoing open resection. In selected patients, minimally invasive pancreaticoduodenectomy is a safe and effective procedure with comparable outcomes to conventional open surgery.