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Updated: Jan 31, 2026

Robot Assisted Distal Pancreatectomy with Celiac Axis Resection DP-CAR for Pancreatic Cancer: Surgical Planning and Technique
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Development of a Modified Textbook Outcome in Evaluating Robot-Assisted Middle Pancreatectomy: A Real-World Study of

Jingfeng Li1,2,3,4,5, Lihan Qian1,2,3,4,5, Zhiwei Xu1,2,3,4,5

  • 1Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Cancer Medicine
|January 30, 2026
PubMed
Abstract

Insights

Modified textbook outcome (mTO) is a practical metric for evaluating robot-assisted middle pancreatectomy (RMP) surgical success. Achieving mTO in RMP correlates with shorter hospital stays and fewer complications.

Area of Science:

  • Surgical Outcomes
  • Robotic Surgery
  • Pancreatic Surgery

Background:

  • Pancreatic fistula is a major complication following robot-assisted middle pancreatectomy (RMP).
  • Textbook outcome (TO) is a metric for ideal surgical results, but its value in RMP is not established.
  • Assessing surgical quality in RMP is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the utility of a modified textbook outcome (mTO) in robot-assisted middle pancreatectomy (RMP).
  • To establish a benchmark for ideal surgical outcomes in RMP procedures.
  • To identify factors influencing surgical success in RMP.

Main Methods:

  • Retrospective analysis of 209 patients undergoing RMP from 2010 to 2023.
  • Calculation of modified textbook outcome (mTO) based on specific complication criteria.
  • Analysis of baseline, operative, and oncological outcomes in relation to mTO.

Main Results:

  • The overall mTO rate was 73.68%, with a modified post-operative pancreatic fistula (mPOPF) rate of 15.79%.
  • Patients achieving mTO experienced significantly shorter post-operative hospitalizations (17 vs. 34 days, p < 0.001).
  • Overcoming the learning curve for RMP reduced mPOPF rates and increased mTO rates.

Conclusions:

  • Modified textbook outcome (mTO) serves as a practical and valuable metric for assessing ideal surgical outcomes in RMP.
  • Further multi-center research is recommended to validate mTO as a standard indicator in RMP.
  • Achieving mTO signifies superior surgical performance and improved patient recovery in RMP.
Keywords:
post‐operative pancreatic fistularobot‐assisted middle pancreatectomytextbook outcome

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