ArticleHepatobiliary surgery and nutrition2026
Independent risk factors for clinically relevant postoperative pancreatic fistula after robotic pancreatoduodenectomy: the protective role of the modified Blumgart pancreatojejunostomy in a single surgeon retrospective cohort of 220 cases.
Article in Hepatobiliary surgery and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) remains the primary driver of morbidity after pancreatoduodenectomy (PD). Although robot-assisted PD (RPD) is increasingly adopted, determinants of CR-POPF in this setting-particularly during program implementation-are not well defined. This study aimed to identify independent risk factors for CR-POPF in a large cohort, with a focus on anastomotic technique and the learning curve. Methods: We retrospectively analyzed 220 consecutive RPDs performed by a single surgeon between October 2015 and December 2024 at the University Hospital of Orléans. Univariate and multivariate logistic regression analyses were used to identify predictors of CR-POPF. The learning curve was assessed using cumulative sum (CUSUM) analysis of operative time, estimated blood loss, CR-POPF rates, risk-adjusted CUSUM (RA-CUSUM) for severe morbidity (Clavien-Dindo grade ≥ III) and RA-CUSUM for textbook outcomes (TOs). Results: CR-POPF occurred in 17% (n=36) of patients. In multivariate analysis, the updated alternative pancreatic fistula risk score (ua-FRS) and conventional pancreatojejunostomy (versus the modified Blumgart technique) were independent risk factors; conventional pancreatojejunostomy conferred the highest risk (odds ratio 3.06; 95% confidence interval: 1.12-8.40; P=0.03). The CUSUM curve for CR-POPF, RA-CUSUM for Clavien-Dindo ≥ III and RA-CUSUM for TOs revealed a consistent inflection around the 65th case, coinciding with the near-exclusive adoption of the modified Blumgart anastomosis. No significant learning effects were observed for operative time or blood loss. Conclusions: In RPD, the modified Blumgart pancreatojejunostomy is independently protective against CR-POPF. Standardizing this technique significantly reduces fistula rates and may shorten the learning curve. These findings support adopting the modified Blumgart reconstruction as the default anastomotic strategy during RPD program implementation.
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