title: Robotic approach mitigates perioperative morbidity in obese patients following pancreaticoduodenectomy.
abstract: The aim was to evaluate the impact of obesity on perioperative outcomes in patients undergoing robotic pancreaticoduodenectomy (RPD) compared to open pancreaticoduodenectomy (OPD).
  
  
  
  A retrospective review of all pancreaticoduodenectomies from 9/2011 to 4/2015 was performed. Obesity was defined as body mass index (BMI) > 30 kg/m2.
  
  
  
  Of 474 pancreaticoduodenectomies performed: RPD = 213 (45%) and OPD = 261 (55%). A total of 145 (31%) patients were obese (70 RPD, 75 OPD). Obese patients had increased EBL (p = 0.03), pancreatic fistula (B&C; p = 0.077), and wound infection (p = 0.068) compared to the non-obese. For obese patients, RPD had decreased OR time (p = 0.0003), EBL (p < 0.001), and wound infection (p = 0.001) with no difference in Clavien ≥3 complications, margins, LOS or 30-day mortality compared with OPD. In multivariate analysis, obesity was the strongest predictor of Clavien ≥3 (OR 1.6; p = 0.041) and wound infection if BMI > 35 (OR 2.6; p = 0.03). The robotic approach was protective of Clavien ≥3 (OR 0.6; p = 0.03) on univariate analysis and wound infection (OR 0.3; p < 0.001) and grade B/C pancreatic fistula (OR 0.34; p < 0.001) on multivariate analysis.
  
  
  
  Obese patients are at risk for increased postoperative complications regardless of approach. However, the robotic approach mitigates some of the increased complication rate, while preserving other perioperative outcomes.
authors.affiliation: UCLA, Department of Surgery, Division of General Surgery, 10833 LeConte Ave, 72-215 CHS, Los Angeles, CA 90095, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Girgis
authors.affiliation: UPMC, Department of Surgery, Division of General Surgery and Epidemiology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA.
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Zenati
authors.affiliation: UPMC, Department of Surgery, Division of Surgical Oncology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steve
authors.affiliation: UPMC, Department of Surgery, Division of Surgical Oncology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.affiliation: UPMC, Department of Surgery, Division of Surgical Oncology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA.
authors.forename: Amer
authors.initials: A
authors.lastname: Zureikat
authors.affiliation: UPMC, Department of Surgery, Division of Surgical Oncology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: UPMC, Department of Surgery, Division of Surgical Oncology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA. Electronic address: hoggme@upmc.edu.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016017:Odds Ratio; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome