title: An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions.
abstract: BACKGROUND
  Proponents of the robotic platform site its potential advantages in complex reconstructions such as the pancreaticojejunal anastomosis; however, the incidence and risk factors for postoperative pancreatic fistula (POPF) after robotic pancreaticoduodenectomy (RPD) have not been characterized.
  
  
  OBJECTIVE
  To identify independent risk factors for POPF after RPD.
  
  
  METHODS
  A prospectively maintained database of patients that underwent RPD (2008-2013) with a standardized pancreaticojejunostomy was analyzed. Univariate and multivariate analyses (UVA/MVA) were used to identify independent predictors for POPF. The POPF prognostic scores developed by Braga and Callery for open pancreaticoduodenectomy were then applied with logistic regression analysis on this RPD cohort.
  
  
  RESULTS
  One hundred and fifty consecutive RPDs were analyzed. POPF occurred in 26 (17.3%); 13 (8.6%) of which were ISGPF category B and C. On UVA, patients with POPF had larger body mass index (BMI), smaller pancreatic duct diameter, smaller tumor size, longer OR time, larger estimated blood loss (EBL) and RBC transfusion (all p < 0.05). Higher EBL, duct size <4 mm, larger BMI and small tumor size remained the best independent risk factors for POPF on MVA. Increased Callery (OR 1.46, 95% CI, p = 0.001) and Braga (OR 1.2, 95% CI, p = 0.005) scores predicted an increased risk of POPF in this RPD cohort.
  
  
  CONCLUSIONS
  Larger BMI, higher EBL, smaller tumor size and smaller duct diameter are the main predictors of POPF in RPD.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA.
authors.forename: Patricio M
authors.initials: PM
authors.lastname: Polanco
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA.
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Zenati
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA.
authors.forename: Murtaza
authors.initials: M
authors.lastname: Shakir
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Boone
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Ste 421, Pittsburgh, PA, 15232, USA. zureikatah@upmc.edu.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010183:Pancreatic Ducts / Q000473:pathology; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects*
keywords: Pancreatic; Surgical; Technical