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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 enable precise surgical manipulation, but its association with postoperative nutritional recovery remains unclear. We compared short-term surgical and nutritional outcomes between RPD and open pancreaticoduodenectomy (OPD).
Methods
We retrospectively reviewed patients who underwent pancreaticoduodenectomy at our institution from January 2017 to December 2023 and compared outcomes between RPD and OPD.
Results
Fifty-seven patients were included (RPD, n=23; OPD, n=34). Compared with OPD, RPD was associated with longer operative time (550 [492–597] vs. 445 [412–521] minutes; P<0.01) but lower blood loss (20 [10–135] vs. 490 [298–848] mL; P<0.01). Major complications (4.3% vs. 35.3%; P<0.01) and clinically relevant postoperative pancreatic fistula (4.3% vs. 32.4%; P=0.02) were less frequent after RPD, and hospital stay was shorter (19 [15–23] vs. 32 [22–39] days; P<0.01). The Prognostic Nutritional Index (PNI) was higher after RPD on postoperative day 7 (35.4 [34.7–36.8] vs. 32.1 [29.9–35.5]; P=0.01), but not on day 14 (37.3 [34.6–40.8] vs. 35.1 [33.8–37.5]; P=0.06). PNI recovery rates were similar between groups.
Conclusion
Among selected patients with noninvasive or low-grade pancreatic pathology, RPD was associated with favorable short-term surgical outcomes and higher PNI on postoperative day 7. However, PNI on day 14 and PNI recovery rates did not differ significantly. Given the retrospective, nonrandomized design and small sample size, these findings do not establish a causal effect of RPD on nutritional recovery.
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