LAUSR

BACKGROUND We aim to assess the safety of an ERAS and early discharge pathway in a robotic pancreatoduodenectomy (PD) program and compare outcomes with an open PD cohort as controls to determine the synergistic effects of robotic surgery and enhanced recovery pathways on length of stay (LOS). STUDY DESIGN Consecutive patients undergoing open or robotic pancreatoduodenectomy by a single surgeon from analysis from March 2020 to July 2022 was identified. Logistic regression models were used for adjusted analyses of postoperative outcomes. RESULTS There were 134 consecutive patients who underwent PD, of which 40 (30%) were performed robotically. Pancreatic adenocarcinoma was the most common indication in both the open (56%) and robotic (55%, p=0.51) groups, with a similar proportion of them being borderline resectable or locally advanced tumors (78% vs 82% in robotic group, p=0.82). The LOS was significantly shorter in the robotic PD group (median 5 days, IQR 4-7 days) when compared to the open PD group (median 6 days, IQR 5-8 days, p<0.001). A LOS of ≤4 days was observed in 40% of the robotic PD group compared to only 3% of patients in the open PD group (p<0.001), with no differences in the overall readmission rates (10% vs 12% in the robotic PD group, p=0.61). On multivariable logistic regression, robotic PD was independently associated with higher odds of LOS of ≤4 days (OR 22.4, p=0.001) when compared to open PD. CONCLUSIONS An enhanced recovery and early discharge pathway could be safely implemented in a robotic PD program. Patients undergoing robotic PD have significantly shorter lengths of stay without increased complication or readmission rates compared to open PD, with 40% of patients undergoing robotic PD achieving a LOS of ≤4 days.