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Conversion of Robotic Distal Pancreatectomy: Predictors and Outcomes in an International Multicenter Study
Philip C Müller1, Philipp Sedlaczek1, Adrian T Billeter1
1Department of Surgery, Clarunis University Digestive Health Care Center, University Hospital Basel, Basel, Switzerland.
Annals of Surgery
|July 3, 2025
Summary
Robotic distal pancreatectomy (RPD) has a low conversion rate, but conversion to open surgery significantly worsens patient outcomes. Careful patient selection using validated scoring systems is crucial for optimal results in RPD procedures.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Robotic distal pancreatectomy (RPD) offers a lower conversion rate compared to laparoscopic approaches.
- Understanding conversion factors and outcomes is vital for refining RDP procedures.
Purpose of the Study:
- To identify risk factors for conversion during RPD.
- To assess the impact of conversion on clinical outcomes after RPD.
Main Methods:
- Retrospective analysis of 2,452 RPD cases across 16 international centers.
- Comparison of perioperative outcomes between converted and non-converted RPD patients.
- Multivariable logistic regression to determine risk factors for conversion.
Main Results:
- A low conversion rate of 3.1% (75/2,452) was observed.
- Converted RPDs had longer operative times, greater blood loss, and increased overall and major complications.
- Converted patients faced higher rates of pancreatic fistula, delayed gastric emptying, and 90-day mortality, with lower textbook outcome rates.
Conclusions:
- RPD demonstrates a low conversion rate, but conversion is associated with significantly worse postoperative outcomes.
- Validated difficulty scoring systems are essential for appropriate patient selection in RPD to minimize conversion risks.
