Robotic Versus Open Pancreatoduodenectomy Shows Comparable Outcomes

Key Takeaways

• Ninety-day mortality, clinically relevant complications including postoperative pancreatic fistula, and reoperation were not significantly different between the two approaches.
• Lymph node yield, R0 resection rate, operative time, and length of hospital stay were also not significantly different.
• Readmission favored open surgery, blood loss favored robotic surgery, and the authors limited equal recommendation of the two approaches to experienced, high-volume centers.

Across seven prospective studies, a systematic review and meta-analysis of robotic versus open pancreatoduodenectomy found broadly similar short-term outcomes between robotic and open partial pancreatoduodenectomy. Ninety-day mortality and major complications were similar overall, while blood loss was lower with robotic surgery and readmission favored open surgery. The comparison was limited to perioperative and other short-term findings.

The analysis compared short-term outcomes of robotic partial pancreatoduodenectomy and open partial pancreatoduodenectomy in the setting of ongoing debate about perioperative advantages and limitations. Investigators searched Medline, Web of Science, and CENTRAL, with the last access on 26 November 2025, and limited inclusion to prospective studies. The main outcome was 90-day mortality, and secondary outcomes included complications and short-term oncologic measures such as R0 resection rate. Results were pooled with a random-effects model, bias tools were matched to study design, certainty was graded with GRADE.

Screening covered 7,388 studies, followed by full-text review of 358 records, and seven studies met inclusion criteria. The final group included three randomized controlled trials and four comparative cohort trials. Pooled 90-day mortality was similar between approaches, with an odds ratio of 1.07 and a 95% confidence interval from 0.04 to 29.40. Clinically relevant complications, including postoperative pancreatic fistula and reoperation, were also similar, with an odds ratio of 1.10 and a 95% confidence interval from 0.47 to 2.59.

Other perioperative and short-term oncologic measures also did not differ meaningfully between groups. Lymph node yield, R0 resection rate, operative time, and length of hospital stay were each not significantly different. Readmission rates favored open pancreatoduodenectomy, with an odds ratio of 1.22 and a 95% confidence interval from 1.15 to 1.28. Intraoperative blood loss favored robotic pancreatoduodenectomy, with a standardized mean difference of -0.98 and a 95% confidence interval from -1.65 to -0.32.

The authors interpreted mortality after robotic pancreatoduodenectomy as comparable with open surgery, along with similar major complications and short-term oncologic outcomes. They stated that robotic pancreatoduodenectomy can be equally recommended as open surgery, while limiting that conclusion to experienced, high-volume centers.