Citations 1
Setting the Standard in Robotic Whipple Surgery
Pfister, Matthias , Li, Zhihao, Araujo, Raphael L. C., Chaudhari, V., Chérif, Rim , Foroutani, Laleh , Ginesini, Michael, Iben-Khayat, Abdallah , Lee, Boram, Nunez, Ricardo, Takishita, Chie, Vigia, Emanuel , Watanabe, Yusuke , Wakabayashi, Taiga , Alseidi, A., Benedetto, Fabrizio Di, Boggi, Ugo, Brustia, Dr Raffaele, Cheung, Tan-To, Dillhoff, Mary E., Goh, BrianK P, Han, Ho-Seong, Ielpo, Benedetto, Lee, Jae Hoon, Machado, Marcel A., Marques, Hugo Pinto, Mejia, Alejandro, Nakamura, Masafumi, Pessaux, Patrick, Polanco, Patricio M., Saint-Marc, Olivier, Shrikhande, S., Wakabayashi, Go, Clavien, Pierre-Alain, Marques, Hugo P. , Li, Zhihao , Ielpo, Benedetto , Clavien, Pierre-Alain , Li, Zhihao , Abbassi, Fariba , Cherif, Rim, Giannone, Fabio , Ginesini, Michael , Underwood, Patrick W. , Vivian, Elaina , Benedetto, Fabrizio Di , Boggi, Ugo , Brustia, Raffaele , Dillhoff, Mary , Goh, Brian K P , Han, Ho-Seong , Lee, Jae Hoon , Martinie, John B. , Mejia, Alejandro , Nagakawa, Yuichi , Nakamura, Masafumi , Pessaux, Patrick , Polanco, Patricio Marcelo , Saint‐Marc, Olivier , Shrikhande, S., Wakabayashi, Go , Clavien, Pierre‐Alain
Annals of Surgery | January 21, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Objective: To establish international benchmark values for relevant outcome parameters in robotic Whipple. Summary Background Data: For safe adoption of surgical innovation, robust quality control is essential. Benchmarking is a validated tool for assessing surgical performance. Recent international consensus identified establishing benchmark values for robotic Whipple as top priority. Methods: We analyzed consecutive patients undergoing robotic Whipple between 2020-2023 with a minimum one-year follow-up. Reference centers were required to perform ≥15 cases/year, be scientifically active in the field, and maintain a prospective database. Benchmark criteria included benign or resectable malignant disease without neoadjuvant therapy, arterial resection, major co-morbidities, or significant previous abdominal surgery. Benchmarks were established for 13 outcome parameters. Result: The benchmark cohort comprised 418 patients from 12 centers across four continents. Benchmark values were: conversion rate ≤4.3%, transfusion rate ≤2.1%, 6-month mortality ≤2.2%, major complications ≤23.2%, and CCI® ≤20.9. Clinically relevant pancreatic fistula (grade B/C) and hemorrhage (grade B/C) rates were ≤23.6% and ≤12.7%, respectively. For pancreatic ductal adenocarcinoma (n=123), the benchmark for lymph node yield was ≥20. Higher surgical difficulty was associated with increased overall postoperative morbidity (R 2 =0.38, P =0.019), higher center caseload with reduced pancreas-specific complications (R 2 =0.28, P =0.044). Independent POPF predictors included duct diameter ≤4 mm (OR 1.37, 95% CI: 1.03, 1.82), anticoagulation (OR 2.45, 95% CI: 1.47, 3.99), and indication other than PDAC (OR 2.33, 95% CI: 1.68, 3.27). Conclusions: This study establishes the first international benchmarks for robotic Whipple, demonstrating oncologic outcomes and morbidity comparable to open surgery with the benefits of minimally invasive surgery.