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Purpose <p>Robotic distal pancreatectomy (RDP) is being adopted increasingly, but its impact on clinically relevant postoperative pancreatic fistula (CR-POPF) compared with that of open distal pancreatectomy (ODP) remains unclear. We compared the incidences of CR-POPF after RDP vs. ODP, focusing on postoperative inflammation and drain bacterial contamination.</p> Methods <p>The subjects of this retrospective analysis were 125 patients who underwent stapler-based distal pancreatectomy at a single center between 2013 and 2025 (RDP, <i>n</i> = 50; ODP, <i>n</i> = 75). Propensity score matching yielded 32 matched patients in each group. Outcomes included CR-POPF, postoperative C-reactive protein, drain amylase levels, and drain fluid cultures on postoperative days (PODs) 1 and 3. Multivariable analysis was performed to identify the factors associated with CR-POPF.</p> Results <p>After matching, it was evident that the RDP group had less blood loss (median 95 vs. 573 mL, <i>p</i> &lt; 0.001) and fewer transfusions (3% vs. 19%, <i>p</i> = 0.045). Positive POD-3 drain cultures were less frequent after RDP (6% vs. 25%, <i>p</i> = 0.039). CR-POPF occurred less often after RDP than ODP (6% vs. 41%, <i>p</i> = 0.001). Exploratory analysis revealed that RDP was associated with a lower incidence of CR-POPF, whereas positive POD 3 drain culture was associated with increased risk.</p> Conclusions <p>RDP was associated with a lower incidence of CR-POPF, which may be related to differences in postoperative inflammation and bacterial contamination.</p>

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Robotic distal pancreatectomy has a lower incidence than open surgery of clinically relevant pancreatic fistula: a propensity score–matched analysis with emphasis on inflammation and microbial contamination

  • 期刊论文

  • 发表日期：

    2026年5月26日

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  • Hironobu Suto,
  • Hiroyuki Matsukawa,
  • Yasuhisa Ando,
  • Minoru Oshima,
  • Yoshio Shimizu,
  • Takuro Fuke,
  • Mina Nagao,
  • Koji Fujita,
  • Kiyoyuki Kobayashi,
  • Hideki Kamada,
  • Hideki Kobara,
  • Kensuke Kumamoto,
  • Keiichi Okano

摘要

Purpose

Robotic distal pancreatectomy (RDP) is being adopted increasingly, but its impact on clinically relevant postoperative pancreatic fistula (CR-POPF) compared with that of open distal pancreatectomy (ODP) remains unclear. We compared the incidences of CR-POPF after RDP vs. ODP, focusing on postoperative inflammation and drain bacterial contamination.

Methods

The subjects of this retrospective analysis were 125 patients who underwent stapler-based distal pancreatectomy at a single center between 2013 and 2025 (RDP, n = 50; ODP, n = 75). Propensity score matching yielded 32 matched patients in each group. Outcomes included CR-POPF, postoperative C-reactive protein, drain amylase levels, and drain fluid cultures on postoperative days (PODs) 1 and 3. Multivariable analysis was performed to identify the factors associated with CR-POPF.

Results

After matching, it was evident that the RDP group had less blood loss (median 95 vs. 573 mL, p < 0.001) and fewer transfusions (3% vs. 19%, p = 0.045). Positive POD-3 drain cultures were less frequent after RDP (6% vs. 25%, p = 0.039). CR-POPF occurred less often after RDP than ODP (6% vs. 41%, p = 0.001). Exploratory analysis revealed that RDP was associated with a lower incidence of CR-POPF, whereas positive POD 3 drain culture was associated with increased risk.

Conclusions

RDP was associated with a lower incidence of CR-POPF, which may be related to differences in postoperative inflammation and bacterial contamination.