Robotic pancreaticoduodenectomy decreases the risk of clinically relevant post-operative pancreatic fistula: a propensity score matched NSQIP analysis

Current state of minimally invasive pancreatic surgery

“…Subsequent multivariate analysis yielded lower rates of total CR‐POPF with RPD (OR, 0.239; p < .001), which was also confirmed with propensity‐matching 51 . This advantageous outcome was supported in a multi‐institutional study by Vining et al 53 in which a higher risk of developing CR‐POPF was reported when undergoing OPD in both multivariate analysis (OR, 1.61; p = .005) and propensity‐matching analysis (OR, 1.54; p = .013). Of note, a soft pancreatic texture and pancreatic duct size <3 mm were risk factors for developing CR‐POPF 51,53 .…”

“…This advantageous outcome was supported in a multi‐institutional study by Vining et al 53 in which a higher risk of developing CR‐POPF was reported when undergoing OPD in both multivariate analysis (OR, 1.61; p = .005) and propensity‐matching analysis (OR, 1.54; p = .013). Of note, a soft pancreatic texture and pancreatic duct size <3 mm were risk factors for developing CR‐POPF 51,53 . The link between lower rates of CR‐POPF and a robotic approach may lie in the improved visualization and, thereby, precision that minimizes surrounding tissue inflammation 51 …”

“…After propensity matching with 152 patients included in each arm, this difference vanished to yield statistically equivalent rates of CR‐POPF in RPD and OPD. In contrast, improvement in rates of CR‐POPF was independently associated with RPD in recent reviews 51,53 . In a single‐institution study, a fistula risk score was calculated based on pancreatic texture, duct size, and blood loss with RPD having statistically better CR‐POPF outcomes for those anastomoses rated moderate‐risk (7.1% vs. 15.2%, p = .008).…”

Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy

“…A recent multicenter NSQIP analysis reported a reduced risk of POPF after robotic as compared to open pancreatoduodenectomy 20 . Therefore, the question arises no diabetes than an elderly patient already suffering from diabetes.…”

Effects of Pancreatic Surgery : Quality of Life, Cost-effectiveness and Postoperative Results

“…Although the field is new, there is some evidence from propensity-score matched studies that robotic pancreaticoduodenectomies might decrease the rate of clinically relevant pancreatic fistula. 176,177 This decrease would be quite intuitive, as robotic surgery improves visualization of the whole area and specifically the pancreatic duct compared to open operations. Such a decrease, if it proves to be consistent in future studies, would have a major impact on the entire population and the complication panorama after PDs; pancreatic leakage being one of the most dangerous complications after pancreatic surgery and a driving force behind many other complications.…”