Impact of Robotic Surgery on Postoperative Pancreatic Fistula for High-Risk Pancreaticojejunostomy after Pancreatoduodenectomy

Introduction:The safety and feasibility of robotic pan-creatoduodenectomy (RPD) in high-risk patients for post-operative pancreaticfistula (POPF) have rarely been inves-tigated, although the rate of POPF is lower than in openpancreatoduodenectomy (OPD). This study aimed to ex-amine the impact of robotic surgery on POPF in high-riskpatients after pancreatoduodenectomy (PD).Methods:Weperformed a retrospective study of 204 patients who un-derwent RPD and OPD between January 2018 and June2023. Of the 204 patients, 126 with high-risk pan-creaticojejunostomies for developing POPF were included.The outcomes of RPD and OPD were compared. Multivariateanalyses were conducted to identify risk factors associatedwith the development of clinically relevant POPF (CR-POPF)after surgery.Results:Of the 126 patients, 50 underwentRPD and 76 underwent OPD. The incidence of CR-POPF wassignificantly lower in the RPD group than in the OPD group(6.0% vs. 38.2%,p<0.001). Multivariate analyses identifiedOPD as an independent risk factor associated with CR-POPF(odds ratio [OR]: 7.87, 95% confidence interval [CI]:2.11-29.4,p= 0.002).Conclusion:This study demonstratedthe impact of robotic surgery on POPF in high-risk patientsafter PD. These results suggest that RPD may be significantlyassociated with a decreased incidence of CR-POPF in high-risk anastomoses.(c) 2025 S. Karger AG, Basel