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. 2025 Jul 3.
doi: 10.1097/SLA.0000000000006821. Online ahead of print.

Conversion of Robotic Distal Pancreatectomy: Predictors and Outcomes in an International Multicenter Study

Philip C Müller  1 , Philipp Sedlaczek  1 , Adrian T Billeter  1 , Baiyong Shen  2 , Jiabin Jin  2 , Felix Nickel  3 , Cristiano Guidetti  4 , Emanuele Kauffmann  5 , Julia Purchla  6 , Caroline Berchtold  1 , Christoph Tschuor  7 , Paul Suno Krohn  7 , Stefan K Burgdorf  7 , Jan Philipp Jonas  8 , Felix Julius Bussmann  8 , Olivier Saint-Marc  9 , Abdallah Iben-Khayat  9 , Paul C M Andel  10 , Izaak Quintus Molenaar  10 , Ulrich Wellner  11 , Tobias Keck  11 , Beat Moeckli  12 , Christian Toso  12 , Fabrizio Di Benedetto  4 , Valentina Valle  13 , Pier Giulianotti  13 , Didier Roulin  14   15 , John Martinie  14 , Martina Rama  16 , Harish Lavu  16 , Charles J Yeo  16 , Parit T Mavani  17 , Mihir M Shah  17 , David A Kooby  17 , Jin He  6 , Ugo Boggi  5 , Thilo Hackert  3 , Inne H M Borel-Rinkes  10 , Pierre-Alain Clavien  8 , Beat P Müller  1 , Christoph Kuemmerli  1
Affiliations

Conversion of Robotic Distal Pancreatectomy: Predictors and Outcomes in an International Multicenter Study

Philip C Müller et al. Ann Surg. .

Abstract

Objective: The aim of this study was to identify risk factors for conversion and assess its consequences on clinical outcomes after robotic distal pancreatectomy (RPD).

Summary of background data: RDP has gained popularity due to its lower conversion rate (3-8%) when compared to laparoscopic distal pancreatectomy (10-20%).

Methods: This retrospective multicenter study included RDPs performed at 16 international centers from May 2007 to March 2024. Perioperative outcomes of patients requiring conversion were compared to fully robotic RDP patients. Risk factors for conversion were identified by multivariable logistic regression analysis.

Results: Of 2,452 patients undergoing RDP, 75 (3.1%) required conversion to open surgery. In converted RDPs, operative time was longer (300 (243-376) vs. 180 (120-240) minutes; P<0.001), and blood loss was greater (500 (200-990) vs. 100 (50-200) ml; P<0.001). Converted patients experienced more overall complications (53% vs. 39%; P=0.017), major complications (41% vs. 25%; P<0.001), and a higher 90-day mortality (5% vs. 3%; P<0.001). Furthermore, both postoperative pancreatic fistula (35% vs. 18%; P<0.001) and delayed gastric emptying (10% vs. 3%; P<0.001) were more frequent in the conversion group. The rate of patients achieving textbook outcome was lower after conversion (57% vs. 74%; P=0.003). In the multivariable analysis, lesion size (>51 mm; OR 2.86 (95% CI 1.56-5.08)), BMI (>28 kg/m2; OR 3.03 (1.75-5.30)), previous abdominal surgery (OR 2.48 (1.31-4.51)), patients outside benchmark criteria (OR 2.09 (1.19-3.72)), and age (>62 years; OR 2.21 (1.24-4.05)) were associated with conversion.

Conclusion: This international cohort study confirmed a very low conversion rate for RDP. Yet, converted cases experienced substantially impaired postoperative outcomes, highlighting the need for adequate patient selection through validated difficulty scoring systems.

Keywords: Robotic surgery; clinical outcomes; conversion; distal pancreatectomy; pancreatic surgery.

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Conflict of interest statement

Conflict of interest: The authors declare that they have no conflict of interest. Conflict of interest: The authors declare no conflicts of interest. This study did not receive any grants or other external financial support.

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