Two-center study evaluates composite outcome after robotic pancreatic enucleation

A retrospective cohort study in Surgical Endoscopy evaluated a proposed textbook outcome for robotic pancreatic enucleation, a parenchyma-sparing procedure for benign or low-grade malignant pancreatic lesions. The study included 31 patients treated at Heidelberg University Hospital between April 2023 and March 2025 and an independent cohort of 48 patients treated at Johns Hopkins between September 2017 and October 2025. The composite required no open conversion, no incomplete resection requiring reoperation, no clinically relevant pancreatic fistula, no other major complications, no 30-day readmission, and no 90-day mortality.

The composite outcome was achieved by 20 Heidelberg patients (64.5%) and 29 Johns Hopkins patients (60.4%). In Heidelberg, six patients (19.4%) developed clinically relevant postoperative pancreatic fistula, four (12.9%) required open conversion, and one (3.2%) required reoperation for incomplete resection. Major complications and 30-day readmission each occurred in two patients (6.5%); there were no deaths within 90 days. Individual components contributing to composite failure differed between institutions. Patients meeting the composite had shorter hospital stays in both cohorts, although numerical differences were not provided in the supplied results.

The proposed measure combines established perioperative endpoints with procedure-specific goals and could support quality assessment. However, the small, retrospective, two-center study limits generalizability. Similar overall achievement rates also masked differences in individual complications, underscoring the importance of reporting component outcomes alongside the composite.