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

Charles C. Vining, Kristine Kuchta, Yaniv Berger, Pierce Paterakos, Darryl Schuitevoerder, Kevin K. Roggin, Mark S. Talamonti, Melissa E. Hogg

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1 Scopus citations


Background: A single-institution study demonstrated robotic pancreaticoduodenectomy (RPD) was protective against clinically-relevant postoperative pancreatic fistula (CR-POPF) compared to open pancreaticoduodenectomy (OPD). We sought to compare the national rate of CR-POPF by approach. Methods: Procedure-targeted pancreatectomy Participant User Data File was queried from 2014 to 2017 for all patients undergoing pancreaticoduodenectomy. A modified fistula risk score was calculated and patients were stratified into risk categories. Multivariate logistic regression and propensity score matching was used. Results: The rate of CR-POPF (15.6% vs. 11.9%; p = 0.026) was higher in OPD compared to RPD. On subgroup analysis, OPD had higher CR-POPF in high risk patients (32.9% vs. 19.4%; p = 0.007). On multivariable analysis OPD was a predictor of increased CR-POPF (Odds Ratio [OR] = 1.61 [1.15–2.25]; p = 0.005). Other operative factors associated with increased CR-POPF included soft pancreatic texture (OR = 2.65 [2.27–3.09]; p < 0.001) and concomitant visceral resection (OR = 1.41 [1.03–1.93]; p = 0.031). Increased duct size (reference <3 mm) was predictive of decreased CR-POPF: 3–6 mm (OR = 0.70 [0.61–0.81]; p < 0.001) and ≥6 mm (OR = 0.47 [0.37–0.60]; p < 0.001). Following propensity score matching, RPD continued to be protective against the occurrence of CR-POPF (OR = 1.54 [1.09–2.17]; p = 0.013). Conclusions: This is the largest multicenter study to evaluate the impact of RPD on POPF. It suggests that RPD can be protective against POPF, especially for high risk patients.

Original languageEnglish (US)
Pages (from-to)367-378
Number of pages12
Issue number3
StatePublished - Mar 2021

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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