Robotic-assisted versus open non-reconstructive pancreatic surgery in children with benign and low-grade malignant pancreatic tumors: a two-center preliminary study.

There is a lack of systematic comparisons of perioperative outcomes between robotic-assisted and open non-reconstructive pancreatic surgery for children's benign or low-grade malignant pancreatic neoplasms. This retrospective two-center study (2019.01-2026.04) analyzed pediatric non-reconstructive pancreatic surgery (distal pancreatectomy/enucleation) for benign/low-grade malignant tumors, comparing robotic and open approaches. Intention-to-treat analysis, subgroup sensitivity analyses, and multivariate logistic regression were performed. A total of 74 pediatric patients were enrolled, with 44 in the robotic group and 30 in the open group. The two groups had comparable overall complication rates (40.9% vs. 40.0%, P = 0.938). Multivariate logistic regression with adjustment for tumor size and procedure type revealed that surgical approach was not independently associated with complications (OR = 0.70, 95% CI: 0.24-2.03, P = 0.513), whereas procedure type was an independent risk factor (enucleation vs. DP: OR = 3.10, 95% CI: 1.12-8.57, P = 0.030). The robotic group had less intraoperative blood loss than the open group [20 (6, 50) ml vs. 50 (30, 163) ml, P = 0.0012], but multivariate adjustment failed to confirm surgical approach as an independent factor influencing blood loss (P = 0.231). Operative time and postoperative hospital stay were comparable between the two groups. Sensitivity analyses in the pancreatic tail subgroup (n = 56) and the DP subgroup (n = 47) yielded results in line with the main analysis. In summary, robotic surgery is safe and viable for pediatric non-reconstructive pancreatic surgery, with complications similar to those of open surgery.