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Postoperative nutritional outcomes after robot-assisted versus open pancreaticoduodenectomy: a retrospective cohort study
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Takahiro Shimaoka
 , Kazuki Sasaki, Shogo Kobayashi, Shinichiro Hasegawa, Daisaku Yamada, Yoshito Tomimaru, Hirofumi Akita, Takehiro Noda, Hidenori Takahashi, Yuichiro Doki, Hidetoshi Eguchi
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Published online September 11, 2026
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DOI: https://doi.org/10.15747/ACNM.26.0069
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 Abstract
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Robot-assisted pancreaticoduodenectomy (RPD) may facilitate precise surgical manipulation through magnified visualization and articulating instruments, but whether it is associated with improved nutritional recovery after pancreaticoduodenectomy remains unclear. This retrospective study compared short-term surgical outcomes and postoperative nutritional parameters between RPD and open pancreaticoduodenectomy (OPD).
Methods
We retrospectively reviewed patients who underwent pancreaticoduodenectomy at our institution from January 2017 to December 2023. Patients were classified according to surgical approach as RPD or OPD, and postoperative surgical and nutritional outcomes were compared between groups.
Results
The analysis included 57 patients, comprising 23 who underwent RPD and 34 who underwent OPD. Compared with OPD, RPD was associated with longer operative time (550 minutes [492–597] vs. 445 minutes [412–521]; P<0.01) but lower intraoperative blood loss (20 mL [10–135] vs. 490 mL [298–848]; P<0.01). Major postoperative complications were less frequent after RPD than after OPD (4.3% vs. 35.3%; P<0.01), as was clinically relevant postoperative pancreatic fistula (4.3% vs. 32.4%; P=0.02). Postoperative hospital stay was also shorter in the RPD group (19 days [15–23] vs. 32 days [22–39]; P<0.01). The Prognostic Nutritional Index (PNI) was higher in the RPD group on postoperative day 7 (35.4 [34.7–36.8] vs. 32.1 [29.9–35.5]; P=0.01). Although PNI remained numerically higher in the RPD group on postoperative day 14 (37.3 [34.6–40.8] vs. 35.1 [33.8–37.5]; P=0.06), this difference was not statistically significant. PNI recovery rates on postoperative days 7 and 14 were similar between groups.
Conclusion
Among selected patients with noninvasive or low-grade pancreatic pathology, RPD was associated with lower intraoperative blood loss, fewer major complications, a lower rate of clinically relevant postoperative pancreatic fistula, shorter postoperative hospital stay, and higher PNI on postoperative day 7 than OPD. PNI on postoperative day 14 and PNI recovery rates did not differ significantly between groups. Because this study was retrospective, nonrandomized, and small, these findings should not be interpreted as evidence of a causal effect of RPD on postoperative nutritional recovery.
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