The PD-ROBOSCORE: A difficulty score for robotic pancreatoduodenectomy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Difficulty scoring systems are crucial for the safe implementation of new surgical procedures.
• Robotic pancreatoduodenectomy is a complex procedure requiring careful risk assessment.
• A validated difficulty score can enhance patient safety and procedural planning.

Purpose of the Study:

• To develop and validate a difficulty score for robotic pancreatoduodenectomy (PD-ROBOSCORE).
• To predict severe postoperative complications following robotic pancreatoduodenectomy.
• To provide a tool for assessing surgical complexity and patient risk.

Main Methods:

• Retrospective observational study design.
• Development in a training cohort (198 cases) and validation in an international multicenter cohort (686 cases).
• Testing on a learning curve cohort (300 cases); difficulty levels defined by cut-offs.

Main Results:

• Key predictors include BMI, tumor resectability, tumor location, pancreatic duct size, ASA class, and hepatic artery origin.
• PD-ROBOSCORE (≥12.51) doubled the risk of severe postoperative complications across all cohorts.
• The score also predicted operative time, blood loss, vein resection, and specific postoperative complications.

Conclusions:

• The PD-ROBOSCORE effectively predicts severe postoperative complications in robotic pancreatoduodenectomy.
• The score is accessible online, facilitating its clinical application.
• PD-ROBOSCORE aids in risk stratification and potentially improves outcomes for this complex surgery.