Robotic approach mitigates perioperative morbidity in obese patients following pancreaticoduodenectomy |
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Authors: | Mark D Girgis Mazen S Zenati Jennifer Steve David L Bartlett Amer Zureikat Herbert J Zeh Melissa E Hogg |
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Institution: | 1. UCLA, Department of Surgery, Division of General Surgery, 10833 LeConte Ave, 72-215 CHS, Los Angeles, CA 90095, USA;2. UPMC, Department of Surgery, Division of General Surgery and Epidemiology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA;3. UPMC, Department of Surgery, Division of Surgical Oncology, UPMC Cancer Pavilion, 5150 Centre Ave, Ste 414, Pittsburgh, PA 15232, USA |
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Abstract: | IntroductionThe aim was to evaluate the impact of obesity on perioperative outcomes in patients undergoing robotic pancreaticoduodenectomy (RPD) compared to open pancreaticoduodenectomy (OPD).MethodsA retrospective review of all pancreaticoduodenectomies from 9/2011 to 4/2015 was performed. Obesity was defined as body mass index (BMI) > 30 kg/m2.ResultsOf 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.ConclusionsObese 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. |
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Keywords: | Correspondence Melissa E Hogg UPMC Department of Surgery Division of Surgical Oncology Scaife Hall Suite 497 3550 Terrace Ave Pittsburgh PA 15213 USA |
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