Delayed gastric emptying after robot-assisted pancreatoduodenectomy: the Transatlantic Robot Pancreas Consortium (TROPANC)

Background: Delayed gastric emptying (DGE) is the most common complication of robot-assisted pancreatoduodenectomy (RPD). Large differences exist in DGE rate between centers and it remains unclear to what extent these are associated with surgical technique. This study assessed differences in DGE rate after RPD and predictors for DGE, including gastrojejunostomy (GJ) technique. Methods: Binational, multicenter retrospective cohort study including patients undergoing RPD from seven centers in the United States of America (USA) and the Netherlands (NL) (2011–2023). Data were retrospectively obtained from prospectively maintained databases. Multivariable analysis determined predictors for DGE, including GJ technique. Primary outcomes were DGE (ISGPS grade B/C), primary DGE (i.e., no other abdominal complications), and secondary DGE. Results: Overall, 1,842 patients undergoing RPD were included (USA 1,342, NL 500). Conversion rate was 5.0%, median hospital stay 8 days (6–13), and in-hospital/30-day mortality 1.5%. The rate of DGE grade B/C was 14.8%, primary DGE 5.7% (relative 38.9%), and secondary DGE 9.0% (relative 61.1%). The rates of DGE grade B/C (10.4% vs 26.8%, p < 0.001) and secondary DGE (4.4% vs 21.7%, p < 0.001) were lower in USA compared to NL, whereas the rate of primary DGE was comparable (6.0% vs 5.1%, p = 0.481). Overall, 1,259 (68.6%) GJs were sutured and 576 (31.4%) stapled. Sutured GJ was associated with a higher rate of DGE grade B/C (adjusted risk 18% vs 9%, p < 0.001) and primary DGE (adjusted risk 7% vs 3%, p < 0.001) compared to stapled GJ. Conclusions: This binational multicenter study found that DGE following RPD is mostly secondary to other complications. The association of stapled GJ with lower DGE rates should be confirmed by randomized studies. The most effective strategy to reduce the rate of DGE after RPD would be to prevent the causal underlying complications, particularly POPF. Graphic Abstract: (Figure presented.)