Robotic pancreatoduodenectomy in the high-difficulty tier: a retrospective cohort stratified by PD-ROBOSCORE

Abstract

As a retrospective feasibility and safety analysis, this study explores the application of robotic pancreatoduodenectomy(RPD) in patients with different PD-ROBOSCORE grades at our center, with a key focus on the safety of RPD for high-difficulty procedures. This study retrospectively analyzed the clinical data of patients who received RPD treatment in Changhai Hospital from 2020 to 2025. According to the PD-ROBOSCORE score, the patients were divided into two groups: high difficulty group and low difficulty group. The perioperative core indicators and postoperative outcomes of the two groups were compared and analyzed, including short-term postoperative complications and overall survival. A retrospective analysis was conducted on 100 RPD patients, classified into low-(score ≤ 12, n = 42) and high-difficulty(score > 12, n = 58) groups. The high-difficulty group was older(64.88 ± 7.73 vs. 59.33 ± 10.81 years, P = 0.003), had higher comorbidity (CCI: 6.00 vs. 4.79, P = 0.011), and more vascular involvement(29.31% vs. 4.76%, P = 0.002). Operative time was similar between groups(266.21 ± 74.79 vs. 257.73 ± 79.66 min, P = 0.588). Major complications (Clavien-Dindo ≥ III) occurred in 5.17% of the high-difficulty group and 9.52% of the low-difficulty group. The median hospital stay was longer in the high-difficulty group (18.5 vs. 13.0 days, P = 0.449). One 90-day mortality occurred in the high-difficulty group. Within this single institution retrospective cohort of rigorously screened candidates at a high-volume center, major perioperative complication rates were numerically comparable between low and high-PD-ROBOSCORE subgroups after technical proficiency in pancreatoduodenectomy was achieved. These observational findings cannot confirm equivalent procedural safety for all high-score patients and require external validation.