Does robotic pancreaticoduodenectomy improve outcomes in patients with high risk morphometric features compared to the open approach

Patrick R. Varley, Mazen S. Zenati, Andrew Klobuka, Juliana Tobler, Ahmad Hamad, Melissa E. Hogg, Herbert J. Zeh, Amir A. Borhani, Amer H. Zureikat

Research output: Contribution to journalArticle

Abstract

Background: We sought to investigate whether robotic pancreatoduodenectomy (RPD) mitigates adverse outcomes in patients with high-risk morphometric features compared to the open approach (OPD). Methods: Morphometric parameters for RPD and OPDs were measured by two blinded radiologists. The morphometric parameter best correlating with adverse outcomes was identified and used in multivariable models to evaluate the impact of surgical approach (open vs. robotic) on outcomes of patients with high-risk morphometric features. Results: Of 282 PDs available for morphometric analysis, 134 (47.5%) underwent RPD. Average Psoas Density demonstrated the most frequent association with adverse outcomes, with correlations to prolonged LOS (ρ= -0.154, p=0.01), severe complications (ρ= -0.159, p=0.007), readmission (ρ= -0.16, p=0.007), and discharge to home (ρ= 0.2, p<0.001). On multivariable analysis of patients with high-risk morphometric features (defined as APD ≤ 50th percentile), RPD was associated with a reduction in the likelihood of prolonged LOS (OR 0.27, p = 0.015) and a trend towards discharge home versus a rehab facility or nursing home (OR 2.26, p = 0.061). Conclusion: This study confirms the association between morphometrics and outcomes following PD, and suggests that the robotic approach may be associated with improved outcomes in PD patients with high-risk morphometric features.

Original languageEnglish (US)
Pages (from-to)695-701
Number of pages7
JournalHPB
Volume21
Issue number6
DOIs
StatePublished - Jun 2019
Externally publishedYes

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Pancreaticoduodenectomy
Robotics
pamidronate
Nursing Homes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Varley, P. R., Zenati, M. S., Klobuka, A., Tobler, J., Hamad, A., Hogg, M. E., ... Zureikat, A. H. (2019). Does robotic pancreaticoduodenectomy improve outcomes in patients with high risk morphometric features compared to the open approach. HPB, 21(6), 695-701. https://doi.org/10.1016/j.hpb.2018.10.016

Does robotic pancreaticoduodenectomy improve outcomes in patients with high risk morphometric features compared to the open approach. / Varley, Patrick R.; Zenati, Mazen S.; Klobuka, Andrew; Tobler, Juliana; Hamad, Ahmad; Hogg, Melissa E.; Zeh, Herbert J.; Borhani, Amir A.; Zureikat, Amer H.

In: HPB, Vol. 21, No. 6, 06.2019, p. 695-701.

Research output: Contribution to journalArticle

Varley, PR, Zenati, MS, Klobuka, A, Tobler, J, Hamad, A, Hogg, ME, Zeh, HJ, Borhani, AA & Zureikat, AH 2019, 'Does robotic pancreaticoduodenectomy improve outcomes in patients with high risk morphometric features compared to the open approach', HPB, vol. 21, no. 6, pp. 695-701. https://doi.org/10.1016/j.hpb.2018.10.016
Varley, Patrick R. ; Zenati, Mazen S. ; Klobuka, Andrew ; Tobler, Juliana ; Hamad, Ahmad ; Hogg, Melissa E. ; Zeh, Herbert J. ; Borhani, Amir A. ; Zureikat, Amer H. / Does robotic pancreaticoduodenectomy improve outcomes in patients with high risk morphometric features compared to the open approach. In: HPB. 2019 ; Vol. 21, No. 6. pp. 695-701.
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AU - Zenati, Mazen S.

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AU - Tobler, Juliana

AU - Hamad, Ahmad

AU - Hogg, Melissa E.

AU - Zeh, Herbert J.

AU - Borhani, Amir A.

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N2 - Background: We sought to investigate whether robotic pancreatoduodenectomy (RPD) mitigates adverse outcomes in patients with high-risk morphometric features compared to the open approach (OPD). Methods: Morphometric parameters for RPD and OPDs were measured by two blinded radiologists. The morphometric parameter best correlating with adverse outcomes was identified and used in multivariable models to evaluate the impact of surgical approach (open vs. robotic) on outcomes of patients with high-risk morphometric features. Results: Of 282 PDs available for morphometric analysis, 134 (47.5%) underwent RPD. Average Psoas Density demonstrated the most frequent association with adverse outcomes, with correlations to prolonged LOS (ρ= -0.154, p=0.01), severe complications (ρ= -0.159, p=0.007), readmission (ρ= -0.16, p=0.007), and discharge to home (ρ= 0.2, p<0.001). On multivariable analysis of patients with high-risk morphometric features (defined as APD ≤ 50th percentile), RPD was associated with a reduction in the likelihood of prolonged LOS (OR 0.27, p = 0.015) and a trend towards discharge home versus a rehab facility or nursing home (OR 2.26, p = 0.061). Conclusion: This study confirms the association between morphometrics and outcomes following PD, and suggests that the robotic approach may be associated with improved outcomes in PD patients with high-risk morphometric features.

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