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An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions

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Abstract

Background

Proponents of the robotic platform site its potential advantages in complex reconstructions such as the pancreaticojejunal anastomosis; however, the incidence and risk factors for postoperative pancreatic fistula (POPF) after robotic pancreaticoduodenectomy (RPD) have not been characterized.

Objective

To identify independent risk factors for POPF after RPD.

Methods

A prospectively maintained database of patients that underwent RPD (2008–2013) with a standardized pancreaticojejunostomy was analyzed. Univariate and multivariate analyses (UVA/MVA) were used to identify independent predictors for POPF. The POPF prognostic scores developed by Braga and Callery for open pancreaticoduodenectomy were then applied with logistic regression analysis on this RPD cohort.

Results

One hundred and fifty consecutive RPDs were analyzed. POPF occurred in 26 (17.3 %); 13 (8.6 %) of which were ISGPF category B and C. On UVA, patients with POPF had larger body mass index (BMI), smaller pancreatic duct diameter, smaller tumor size, longer OR time, larger estimated blood loss (EBL) and RBC transfusion (all p < 0.05). Higher EBL, duct size <4 mm, larger BMI and small tumor size remained the best independent risk factors for POPF on MVA. Increased Callery (OR 1.46, 95 % CI, p = 0.001) and Braga (OR 1.2, 95 % CI, p = 0.005) scores predicted an increased risk of POPF in this RPD cohort.

Conclusions

Larger BMI, higher EBL, smaller tumor size and smaller duct diameter are the main predictors of POPF in RPD.

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Acknowledgments

Dr. Hogg received support from Intuitive Surgical Inc in the form of an educational training Grant, to study a proficiency-based virtual reality simulator training curriculum for surgical oncology fellows in 2014.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA

    Patricio M. Polanco, Mazen S. Zenati, Melissa E. Hogg, Murtaza Shakir, Brian A. Boone, David L. Bartlett, Herbert J. Zeh & Amer H. Zureikat

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  1. Patricio M. Polanco
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  2. Mazen S. Zenati
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  3. Melissa E. Hogg
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  4. Murtaza Shakir
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  5. Brian A. Boone
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  6. David L. Bartlett
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  7. Herbert J. Zeh
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  8. Amer H. Zureikat
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Correspondence to Amer H. Zureikat.

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Disclosures

Drs. Polanco, Zenati, Shakir, Boone, Bartlett, Zeh and Zureikat have no conflict of interest or financial ties to disclose.

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Polanco, P.M., Zenati, M.S., Hogg, M.E. et al. An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions. Surg Endosc 30, 1523–1529 (2016). https://doi.org/10.1007/s00464-015-4366-8

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  • DOI: https://doi.org/10.1007/s00464-015-4366-8

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