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Robotic Pancreaticoduodenectomy Is Associated with Decreased Clinically Relevant Pancreatic Fistulas: a Propensity-Matched Analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD) is a major complication that adversely affects recovery. The robotic approach may decrease the incidence of this complication. This propensity-matched analysis evaluates the impact of robotic PD (RPD) on CR-POPF.

Methods

Patients undergoing PD after the learning curve at a high-volume academic medical center were reviewed. CR-POPF outcomes after open PD (OPD) and RPD were compared. Logistic regression and propensity score matching (PSM) were used to define the independent effect of RPD on CR-POPF.

Results

Of 865 PDs performed over the study period, 405 (46.8%) were OPD and 460 (53.2%) were RPD. RPD was associated with a similar overall POPF rate, but a lower incidence of CR-POPF (6.7% vs. 15.8%, p < 0.001). On multivariate analysis, RPD was an independent predictor of lower CR-POPF (OR 0.278, p < 0.001). Following propensity matching, RPD continued to be protective against the occurrence of CR-POPF (coefficient = − 0.113, p = 0.001).

Conclusions

This is the largest single-center PSM analysis to evaluate the impact of robotic approach on pancreatoduodenectomy and suggests that RPD can minimize the clinical impact of pancreatic leaks after PD.

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Author notes

  1. Jianpeng Cai and Rajesh Ramanathan contributed equally to this work

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Jianpeng Cai

  2. Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 421, Pittsburgh, PA, 15232, USA

    Rajesh Ramanathan, Amr Al Abbas & Amer H. Zureikat

  3. Department of Surgery and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Mazen S. Zenati

  4. Department of Surgery, NorthShore Hospital, Chicago, IL, USA

    Melissa E. Hogg

  5. Department of Surgery, University of Texas Southwestern, Dallas, TX, USA

    Herbert J. Zeh

Authors
  1. Jianpeng Cai
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  2. Rajesh Ramanathan
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  3. Mazen S. Zenati
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  4. Amr Al Abbas
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  5. Melissa E. Hogg
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  7. Amer H. Zureikat
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Contributions

JC contributed to design, acquisition, and interpretation of data and drafting. RR contributed to interpretation and drafting. MZ contributed to data analysis and interpretation. AA contributed to data acquisition. ME and HZ contributed to interpretation and critical review. AZ contributed to design, and critical review. All authors provide final approval and agreement to accountability.

Corresponding author

Correspondence to Amer H. Zureikat.

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This study was approved by our institutional review board (IRB).

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The authors declare that they have no conflict of interest.

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Cai, J., Ramanathan, R., Zenati, M.S. et al. Robotic Pancreaticoduodenectomy Is Associated with Decreased Clinically Relevant Pancreatic Fistulas: a Propensity-Matched Analysis. J Gastrointest Surg 24, 1111–1118 (2020). https://doi.org/10.1007/s11605-019-04274-1

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  • DOI: https://doi.org/10.1007/s11605-019-04274-1

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