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

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

doi:10.1097/SLA.0000000000006821

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

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

^*Corresponding author af dette arbejde

Afdeling for Transplantation og Sygdomme i Fordøjelsessystemet CKO

2 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	Annals of Surgery
ISSN	0003-4932
DOI	https://doi.org/10.1097/SLA.0000000000006821
Status	E-pub ahead of print - 3 jul. 2025

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10.1097/SLA.0000000000006821Licens: CC BY

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Müller, P. C., Sedlaczek, P., Billeter, A. T., Shen, B., Jin, J., Nickel, F., Guidetti, C., Kauffmann, E., Purchla, J., Berchtold, C., Tschuor, C., Krohn, P. S., Burgdorf, S. K., Jonas, J. P., Bussmann, F. J., Saint-Marc, O., Iben-Khayat, A., Andel, P. C. M., Molenaar, I. Q., ... Kuemmerli, C. (2025). Conversion of Robotic Distal Pancreatectomy: Predictors and Outcomes in an International Multicenter Study. Annals of Surgery. Advance online publication. https://doi.org/10.1097/SLA.0000000000006821

Müller, PC, Sedlaczek, P, Billeter, AT, Shen, B, Jin, J, Nickel, F, Guidetti, C, Kauffmann, E, Purchla, J, Berchtold, C, Tschuor, C , Krohn, PS , Burgdorf, SK, Jonas, JP, Bussmann, FJ, Saint-Marc, O, Iben-Khayat, A, Andel, PCM, Molenaar, IQ, Wellner, U, Keck, T, Moeckli, B, Toso, C, Di Benedetto, F, Valle, V, Giulianotti, P, Roulin, D, Martinie, J, Rama, M, Lavu, H, Yeo, CJ, Mavani, PT, Shah, MM, Kooby, DA, He, J, Boggi, U, Hackert, T, Borel-Rinkes, IHM, Clavien, P-A, Müller, BP & Kuemmerli, C 2025, 'Conversion of Robotic Distal Pancreatectomy: Predictors and Outcomes in an International Multicenter Study', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000006821

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title = "Conversion of Robotic Distal Pancreatectomy: Predictors and Outcomes in an International Multicenter Study",

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 = "clinical outcomes, conversion, distal pancreatectomy, pancreatic surgery, Robotic surgery",

author = "M{\"u}ller, {Philip C} and Philipp Sedlaczek and Billeter, {Adrian T} and Baiyong Shen and Jiabin Jin and Felix Nickel and Cristiano Guidetti and Emanuele Kauffmann and Julia Purchla and Caroline Berchtold and Christoph Tschuor and Krohn, {Paul Suno} and Burgdorf, {Stefan K} and Jonas, {Jan Philipp} and Bussmann, {Felix Julius} and Olivier Saint-Marc and Abdallah Iben-Khayat and Andel, {Paul C M} and Molenaar, {Izaak Quintus} and Ulrich Wellner and Tobias Keck and Beat Moeckli and Christian Toso and {Di Benedetto}, Fabrizio and Valentina Valle and Pier Giulianotti and Didier Roulin and John Martinie and Martina Rama and Harish Lavu and Yeo, {Charles J} and Mavani, {Parit T} and Shah, {Mihir M} and Kooby, {David A} and Jin He and Ugo Boggi and Thilo Hackert and Borel-Rinkes, {Inne H M} and Pierre-Alain Clavien and M{\"u}ller, {Beat P} and Christoph Kuemmerli",

note = "Copyright {\textcopyright} 2025 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2025",

month = jul,

day = "3",

doi = "10.1097/SLA.0000000000006821",

language = "English",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Wolters Kluwer Health",

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TY - JOUR

T1 - Conversion of Robotic Distal Pancreatectomy

T2 - Predictors and Outcomes in an International Multicenter Study

AU - Müller, Philip C

AU - Sedlaczek, Philipp

AU - Billeter, Adrian T

AU - Shen, Baiyong

AU - Jin, Jiabin

AU - Nickel, Felix

AU - Guidetti, Cristiano

AU - Kauffmann, Emanuele

AU - Purchla, Julia

AU - Berchtold, Caroline

AU - Tschuor, Christoph

AU - Krohn, Paul Suno

AU - Burgdorf, Stefan K

AU - Jonas, Jan Philipp

AU - Bussmann, Felix Julius

AU - Saint-Marc, Olivier

AU - Iben-Khayat, Abdallah

AU - Andel, Paul C M

AU - Molenaar, Izaak Quintus

AU - Wellner, Ulrich

AU - Keck, Tobias

AU - Moeckli, Beat

AU - Toso, Christian

AU - Di Benedetto, Fabrizio

AU - Valle, Valentina

AU - Giulianotti, Pier

AU - Roulin, Didier

AU - Martinie, John

AU - Rama, Martina

AU - Lavu, Harish

AU - Yeo, Charles J

AU - Mavani, Parit T

AU - Shah, Mihir M

AU - Kooby, David A

AU - He, Jin

AU - Boggi, Ugo

AU - Hackert, Thilo

AU - Borel-Rinkes, Inne H M

AU - Clavien, Pierre-Alain

AU - Müller, Beat P

AU - Kuemmerli, Christoph

PY - 2025/7/3

Y1 - 2025/7/3

N2 - 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.

AB - 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.

KW - clinical outcomes

KW - conversion

KW - distal pancreatectomy

KW - pancreatic surgery

KW - Robotic surgery

UR - http://www.scopus.com/inward/record.url?scp=105010972708&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000006821

DO - 10.1097/SLA.0000000000006821

M3 - Journal article

C2 - 40607707

SN - 0003-4932

JO - Annals of Surgery

JF - Annals of Surgery

ER -

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

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