Robotic versus open pancreatoduodenectomy in patients with obesity: propensity score-matched multicentre study

@article{valle2026robotic,
  title = {{Robotic versus open pancreatoduodenectomy in patients with obesity: propensity score-matched multicentre study}},
  author = {Valentina Valle and Tiziana Marchese and Benedetto Ielpo and Annalisa Comandatore and Marcello Spampinato and Leonardo Borgioli and Gregorio Di Franco and Pier Cristoforo Giulianotti and Luca Morelli and M De Pastena and M De Pastena and A Esposito and R Salvia and G Ietto and R Delpini and T Hackert and F Gehrisch and K Afshar-Bakshloo and F G Uzunoglu and S Ross and G Vanterpool and F Berrevoet and L Standaert and D Citterio and V Mazzaferro and M Cereda and T Ishizawa and A Malpaga and M Ciola and F Gasparin and F Maroso and R Romito and E Poletto and A Ruzzenente and N Furbetta and S Guadagni and G Marchegiani and F Cobellis and A Iacomino and G Zanus and F Giannone and F Matarazzo and M Scheiterle and R Rhaiem and P Zimmermann and J Martinie and R Memba Ikuga and M Defez and E Jovine and L Mastrangelo and E Vicente and V Ferri and Y Quijano and R Caruso and S Delis and C J Wray and F Maffeis and T Perra and A Porcu and A Anselmo},
  journal = {BJS Open},
  year = {2026},
  month = oct,
  doi = {10.1093/bjsopen/zrag107},
  url = {https://doi.org/10.1093/bjsopen/zrag107},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Robotic versus open pancreatoduodenectomy in patients with obesity: propensity score-matched multicentre study
AU  - Valentina Valle
AU  - Tiziana Marchese
AU  - Benedetto Ielpo
AU  - Annalisa Comandatore
AU  - Marcello Spampinato
AU  - Leonardo Borgioli
AU  - Gregorio Di Franco
AU  - Pier Cristoforo Giulianotti
AU  - Luca Morelli
AU  - M De Pastena
AU  - M De Pastena
AU  - A Esposito
AU  - R Salvia
AU  - G Ietto
AU  - R Delpini
AU  - T Hackert
AU  - F Gehrisch
AU  - K Afshar-Bakshloo
AU  - F G Uzunoglu
AU  - S Ross
AU  - G Vanterpool
AU  - F Berrevoet
AU  - L Standaert
AU  - D Citterio
AU  - V Mazzaferro
AU  - M Cereda
AU  - T Ishizawa
AU  - A Malpaga
AU  - M Ciola
AU  - F Gasparin
AU  - F Maroso
AU  - R Romito
AU  - E Poletto
AU  - A Ruzzenente
AU  - N Furbetta
AU  - S Guadagni
AU  - G Marchegiani
AU  - F Cobellis
AU  - A Iacomino
AU  - G Zanus
AU  - F Giannone
AU  - F Matarazzo
AU  - M Scheiterle
AU  - R Rhaiem
AU  - P Zimmermann
AU  - J Martinie
AU  - R Memba Ikuga
AU  - M Defez
AU  - E Jovine
AU  - L Mastrangelo
AU  - E Vicente
AU  - V Ferri
AU  - Y Quijano
AU  - R Caruso
AU  - S Delis
AU  - C J Wray
AU  - F Maffeis
AU  - T Perra
AU  - A Porcu
AU  - A Anselmo
PY  - 2026
DA  - 2026/10/27
JO  - BJS Open
DO  - 10.1093/bjsopen/zrag107
UR  - https://doi.org/10.1093/bjsopen/zrag107
AB  - Background: Obesity increases morbidity after major abdominal surgery. Although the use of robotic pancreatoduodenectomy (RPD) is increasing, evidence of its outcomes in patients with obesity remains limited. This study compared perioperative outcomes of RPD versus open pancreatoduodenectomy (OPD) in patients with obesity.  Methods: This was a retrospective multicentre cohort study of patients with a body mass index (BMI) ≥ 30 kg/m2 undergoing RPD or OPD between 2012 and 2024. Propensity score matching (PSM) was used to minimize selection bias. The primary outcome was severe complications (Clavien–Dindo ≥ IIIa). Secondary outcomes included blood loss, clinically relevant postoperative pancreatic fistula (CR-POPF), clinically relevant delayed gastric emptying (CR-DGE), wound infection, length of hospital stay (LOS), 90-day mortality, and R0 resection. Factors independently associated with severe complications and CR-POPF were investigated using multivariable logistic regression. Fistula risk was classified based on the Updated Alternate Fistula Risk Score (Pancreatic Fistula Risk Score, PFRS).  Results: In all, 591 patients from 31 centres were analysed. After PSM, 166 patients undergoing RPD were compared to 166 undergoing OPD. In the PSM cohort, RPD was associated with significantly lower rates of severe complications (15.7% versus 27.7%; P = 0.007), CR-POPF (8.4% versus 18%; P = 0.011), CR-DGE (9% versus 18.7%; P = 0.022), and wound infection (4.2% versus 21%; P < 0.001). Median blood loss was lower in the RPD than OPD group (100 versus 200 ml; P < 0.001), as was median LOS (11 versus 17 days; P < 0.001). No differences were observed in 90-day mortality or R0 resection rates. Charlson co-morbidity index (odds ratio (OR) 0.68, 95% confidence interval (CI) 0.59-0.83, P = 0.003), robotic approach (OR 0.39, 95%CI 0.18-0.60, P = 0.002), and institutional experience of ≥ 20 robotic resections (OR 0.36, 95%CI 0.27-0.52, P = 0.007) were independently associated with lower CR-POPF risk, whereas a higher PFRS was associated with increased CR-POPF risk (OR 1.73, 95%CI 1.02-1.85, P = 0.032). Similarly, institutional experience of ≥ 20 robotic resections was independently associated with a lower incidence of severe complications (OR 0.39, 95%CI 0.22-0.81, P = 0.003), whereas a higher PFRS independently predicted severe complications (OR 1.93, 95%CI 1.07-2.31, P = 0.006).  Conclusions: RPD is a safe and effective alternative to OPD in patients with obesity when performed in experienced centres. These findings support the adoption of RPD in select high-BMI populations in experienced institutions.
SN  - 2474-9842
ER  -