Impact of body mass index on the early experience of robotic pancreaticoduodenectomy

Abstract

Obesity increases surgical morbidity and mortality in open pancreaticoduodenectomy (OPD). Its influence on robotic pancreaticoduodenectomy (RPD) remains uncertain. This study aimed to investigate the impact of body mass index (BMI) on the early experience of RPD. Between June 2015 and April 2020, 68 consecutive RPDs were performed at the National Cheng Kung University Hospital. The patients were categorized as normal-weight (BMI < 23 kg/m2), overweight (BMI = 23–27.5 kg/m2), and obese (BMI > 27.5 kg/m2) according to the definition of obesity in Asian people from the World Health Organization expert consultation. Preoperative characteristics, operative details, and postoperative outcomes were prospectively collected. The cumulative sum was used to assess the learning curves. The average age of the patients was 64.8 ± 11.7 years with an average BMI of 24.6 ± 3.7 kg/m2 (23 normal-weight, 29 overweight, and 16 obese patients). Eighteen patients were required to overcome the learning curve. The overall complication rate was 51.5%, and the major complication rate (Clavien grade ≥ III) was 19.1%. The normal-weight group showed the most favorable outcomes. The blood loss, major complication rate, peripancreatic fluid collection rate, and conversion rate were higher in the obese group than in the non-obese group. There were no differences in the operative time, clinically relevant postoperative pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, bile leak, wound infection, reoperation, hospital stay, and readmission rate between the obese and non-obese groups. Multivariate analysis showed obesity as the only independent factor for major complications (OR: 5.983, CI: 1.394–25.682, p = 0.001), indicating that obesity should be considered as a surgical risk factor during the implementation of RPD.

Initial 50 consecutive full-robotic pancreatoduodenectomies without conversion by a single surgeon: a learning curve analysis from a tertiary referral high-volume center

“…The median LOS was 10 days [8][9][10][11][12][13][14][15][16][17][18]75]. Twenty out of 50 (40%) patients were discharged within POD 8.…”

“…Conversion rates for R-PD, although lower than those reported for L-PD [ 10 , 11 ], remain quite high and vary widely in the reported literature, ranging from 1.1 to 35% [ 12 , 13 ]. Risk factors currently associated with higher conversion rates are vascular involvement, older age (≥ 75 years), high BMI, tumor size > 40 mm, chronic pancreatitis, poor nutrition (low albumin levels), and smoking [ 11 , 14 , 15 ].…”

Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy - Propensity Score-matched Analysis

“…), other confounders may have affected outcomes. Furthermore, the RPD results in obese patients may differ, as studies have shown that this cohort has longer operation times, more blood loss, and overall and major complications 41 . RCTs comparing OPD and RPD are currently performed and results are awaited in the next years 42 …”

Nomogram predicts CR-POPF in open central pancreatectomy patients with benign or low-grade malignant pancreatic neoplasms

“…The common complication of post-operative peripancreatic fluid accumulation in overweight/obese patients may be attributed to a wider resection area, more tissue damage, larger dead space, more frequent drainage dysfunction and delayed mobilization than in patients with normal BMI ( 29 ). Obese patients also have a stronger inflammatory response to surgical invasion ( 30 ) and high levels of inflammatory factors in patients with high BMI have also been found ( 31 ).…”