Patrick R Varley1, Mazen S Zenati2, Andrew Klobuka3, Juliana Tobler3, Ahmad Hamad1, Melissa E Hogg1, Herbert J Zeh1, Amir A Borhani4, Amer H Zureikat5. 1. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 2. Department of Surgery and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 3. Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: borhaniaa@upmc.edu. 5. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: zureikatah@upmc.edu.
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.
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 PDpatients with high-risk morphometric features.
Authors: Phoebe B McAuliffe; Abhishek A Desai; Ankoor A Talwar; Robyn B Broach; Jesse Y Hsu; Joseph M Serletti; Tiange Liu; Yubing Tong; Jayaram K Udupa; Drew A Torigian; John P Fischer Journal: Ann Surg Date: 2022-07-15 Impact factor: 13.787
Authors: Amer H Zureikat; Joal D Beane; Mazen S Zenati; Amr I Al Abbas; Brian A Boone; A James Moser; David L Bartlett; Melissa E Hogg; Herbert J Zeh Journal: Ann Surg Date: 2021-05-01 Impact factor: 13.787
Authors: Patricia C Conroy; Lucia Calthorpe; Joseph A Lin; Sarah Mohamedaly; Alex Kim; Kenzo Hirose; Eric Nakakura; Carlos Corvera; Julie Ann Sosa; Ankit Sarin; Kimberly S Kirkwood; Adnan Alseidi; Mohamed A Adam Journal: Ann Surg Oncol Date: 2021-11-01 Impact factor: 4.339