# Outcomes After Robot-Assisted Versus Open Pancreatoduodenectomy: A Propensity Score-Matching Analysis in a High-Volume Center (TAKUMI-7)

## TL;DR

Robot-assisted pancreatoduodenectomy shows better short-term outcomes than open surgery, including fewer complications and faster recovery.

## Contribution

This study provides evidence of the potential superiority of robot-assisted surgery over open surgery in pancreatoduodenectomy.

## Key findings

- Robotic surgery was associated with shorter operative time, less blood loss, and shorter hospital stays.
- The robotic group had a higher textbook outcome achievement rate and fewer major complications.
- Robotic surgery was identified as an independent predictor of textbook outcomes.

## Abstract

The advantages of robot-assisted pancreatoduodenectomy (RPD) over open pancreatoduodenectomy (OPD) are currently unknown. In this study of 400 patients (162 with RPD and 238 with OPD), outcomes were compared using propensity score-matching (PSM) analysis. RPD demonstrated superior outcomes, including higher textbook outcome (TO) achievement rates before and after PSM. Moreover, robotic surgery was found to be significantly associated with TO after pancreatoduodenectomy. These results highlight the potential superiority of RPD over OPD in terms of short-term outcomes. Further investigation is warranted to confirm the potential long-term benefits of robotic surgeries.

Background/Objectives: Although the safety and feasibility of robot-assisted pancreatoduodenectomy (RPD) compared to open pancreatoduodenectomy (OPD) have been reported, studies investigating the advantages of RPD remain limited. Moreover, only a few studies have investigated the effects of robotic surgery on textbook outcomes (TO). Methods: This single-center retrospective study included 400 patients who underwent RPD and OPD at our institution between January 2017 and December 2025. Outcomes were compared between the RPD (n = 162) and OPD (n = 238) groups using propensity score-matching (PSM) analysis. The factors associated with TO were examined. Results: Before PSM, significant differences were observed between the groups. PSM yielded RPD (n = 117) and OPD (n = 117) with equal preoperative factors. The RPD group demonstrated a significantly shorter operative time (402 vs. 444 min, p < 0.001), lesser blood loss (75 vs. 270 mL, p < 0.001), shorter postoperative hospital stays (13 vs. 22 days, p < 0.001), and fewer major complications (17.1 vs. 44.4%, p < 0.001), resulting in a higher TO achievement rate (76.9 vs. 52.1%, p = 0.001). Adjusted multivariate analyses identified robotic surgery (odds ratio 3.04, p < 0.001) as an independent predictor of TO. Conclusions: This study demonstrated that RPD was potentially superior to OPD in terms of short-term outcomes. Robotic surgery was significantly associated with TO after pancreatoduodenectomy at the expert’s hand.