The Impact of Obesity on Intraoperative, Oncological, and Postoperative Endpoints in Robotic Pancreaticoduodenectomy

Robot-assisted pancreaticoduodenectomy (PD) has emerged as a surgical technique for an operation known for high postoperative morbidities. However, its impact on intraoperative and oncologic endpoints, and postoperative outcomes across higher body mass index (BMI) groups is not well established.

We conducted a retrospective analysis of 116 patients undergoing robot-assisted PD between 2018 and 2023, categorized by BMI into underweight/normal, overweight, and obese groups. Intraoperative (operative time, estimated blood loss), oncologic (lymph node yield, positive nodes), and postoperative (length of stay, composite adverse events) outcomes were compared using multivariate regression analysis.

Among 116 patients undergoing robot-assisted PD, 31.9% were underweight/normal, 45.7% overweight, and 22.1% were obese. Operative time (obese: 321.88 ± 77.87 min; overweight: 311.45 ± 71.21 min; normal: 304.16 ± 67.80 min; p = 0.63) and estimated blood loss (obese: 94.81 ± 81.57 mL; overweight: 115.00 ± 161.53 mL; normal: 104.3 ± 101.1 mL; p = 0.80) were similar across BMI groups. Lymph node yield did not significantly differ (obese: 24.81 ± 9.07; overweight: 21.83 ± 5.90; normal: 20.97 ± 5.06; p = 0.06). However, obese patients experienced a significantly higher rate of composite adverse events (CAE) (42.31%) than overweight (13.21%) and normal BMI groups (18.92%; p = 0.01). In the multivariable analysis, obesity was associated with increased odds of CAE (OR 3.50, 95% CI: 1.01-2.16). However, operative time, blood loss, lymph node yields, and length of stay did not have significant association with BMI.

Higher BMI was not associated with worse intraoperative and oncologic surgical quality with robot-assisted PD. However, obese patients were more likely to experience postoperative complications after robot-assisted PDs.