Safety and hazards of middle-life robotic pancreaticoduodenectomy

Safety and hazards of middle-life robotic pancreaticoduodenectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety and hazards of middle-life robotic pancreaticoduodenectomy Hassan A. Saad, Azza Baz, Mohamed Riad, Mohamed E Eraky, Ahmed K El-Taher, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3410686/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Pancreaticoduodenectomy procedures were performed early in young individuals, with a few days about the risk and survival after robotic pancreaticoduodenectomy. Our goal was to report the results of robotic pancreaticoduodenectomy in patients older than 50 years. Methods Our patients were divided into two groups: younger patients (less than 50 years) and older patients (> 50 years). A total of 1110 patients were included in this study:1004 (90.5%) in the elderly group and 106 (9.5%) in the young group. Results In younger demographics, the prevalence of periampullary cancer is 32.1% as opposed to 76.5%. 2. Tumors biological (15.1% versus 3.6%). 3. Pseudocapillary and solid malignancies (9.4% and 1.0%, respectively). 4. The tissues soft of the pancreas (77.4% vs. 62.5%). There was a higher prevalence of non-dilated (≤ 3 mm) ducts within the pancreas (77.4% vs. 46.3%) in the younger group. 6. Young people group's hospitalization was less (median, 16 vs. 20 days). 7- The younger group fared better after treatment for total periampullary cancers of the with a 5-year prognosis of 76.4% compared to 46.7% in the older category. 8. The results of the other surgeries didn't vary significantly. Conclusions Robotic pancreaticoduodenectomy is associated with favorable survival outcomes for periampullary cancer in younger people (<50 years) and equivalent surgical outcomes compared to older individuals (≥50 years). These outcomes show that robotic pancreaticoduodenectomy is safe and effective in a subset of pediatric patients. Following pancreaticoduodenectomy, the number of juvenile robotic tumor adenocarcinomas Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Complex and challenging pancreaticoduodenectomy, sometimes called the "Whipple operation," is typically performed in elderly patients with pancreatic cancer and periampullary diseases. Younger patients rarely undergo pancreaticoduodenectomy, and the impact of age on surgical and survival outcomes remains unclear [1]. Patients in their 30s or 40s are rarely found to have pancreatic duct adenocarcinoma, which is often detected in patients aged 65–75 years of age [2, 3]. The influence of youth on surgical and survival outcomes following pancreaticoduodenectomy has not been thoroughly investigated given its uncommon occurrence in younger patients. There is limited literature in this field [1, 2, 4, 5]. Traditionally, an open technique is used to perform pancreaticoduodenectomy using a high abdominal incision, right saber slash, or lengthy upper midline incision. This leads to severe pain and, sometimes, even negative outcomes [6]. Minimally invasive surgery (MIS) has become the norm in several specialties, including pancreatic resection, owing to reduced pain, improved cosmesis, and smaller incisions. According to certain findings, older people can have laparoscopic pancreaticoduodenectomy (LPD) with good results [7–9]. However, pancreaticoduodenectomy entails precise identification of the vital vascular anatomy, considerable dissection and removal of visceral organs, and technically challenging repair. As a result, minimally invasive pancreaticoduodenectomy is not widely used [10]. In light of the limits of laparoscopic surgery, the possibility of automated surgery has lately surfaced, thanks to the introduction of the Intelligent Surgical® da Vinci Robotic Surgical Machine (Sunnyvale, California, USA). With the use of this sort of technology, surgeons can perform tremor-free operations with their instruments and cameras, monitor the surgical region in three dimensions with higher resolution, and increase their range of motion by using endoscopes that mirror open surgical techniques. Although these improvements improve flexibility, reduce tiredness in surgeons, and improve design, they are not as widely employed due to their substantial medical expenses and lack of operator expertise [10, 11]. Despite its sluggish adoption, numerous research investigations have shown that robotic pancreaticoduodenectomy (RPD) is a secure and feasible approach when contrasted with laparotomy [6, 10, 12, 13]. There's a dearth of studies on pancreaticoduodenectomy in patients who are younger; therefore, most of the available data on the results of surgery and therapeutic options originates from investigations of older people. Consequently, it is uncertain how cancer biology and treatment results vary between both elderly and younger populations. RPD in younger demographics has not been the subject of any studies yet. Our research evaluated a younger participant population (less than 50 years old) receiving RPD at our facility with an older patient cohort (> 50 years old) undergoing RPD in order to gain insight into the clinicopathological features, surgery-related results, and longevity results of these young individuals. Patients and methods Patient Choice The study included patients who underwent RPD at 7 surgical institutes between January 2012 and October 2023, and data were collected at our institute; 74 cases later, the learning curve for the RPD was surmounted. The first RPD was completed in January 2012. The patients were divided into two categories based on age: young (less than 50 years) and old (> 50 years). Any patient with a history of surgery and marked adhesion > 2 cm, especially in the upper part of the abdomen, was excluded from our study. Data gathering All data related to patient characteristics and tumor features were collected, and patients were classified physically by the American Society of Anesthesiologists (ASA). All Preoperative, intraoperative, and post operative morbidities were evaluated. The likelihood associated with surgery, such as fatality and different postoperative difficulties, was also evaluated. Incidence of periampullary adenocarcinoma death has also been reported. Aim of Study Outcomes : The primary aim of this study was to compare the safety and risks of our case categories. The secondary study goal was to compare survival between the two groups. Method procedures A brief internal stent was inserted for a small pancreatic duct measuring less than 3 mm, although pancreatic duct stents are not commonly employed. The same jejunal limb was then used for hepaticojejunostomy without stenting, with either continuous (for dilated) or interrupted (for non dilated ducts) sutures. By carefully lowering the stomach, an extracorporeal technique was used to perform a hand-sewn gastrojejunostomy. The gastrojejunostomy was placed in framesocolic, antecolic, and antiperistaltic positions close to the umbilical region. When feasible, a restricted antrectomy was performed following right gastric artery bifurcation in patients with an ischemic pylorus, instead of attempting pylorus-preserving pancreaticoduodenectomy. Oral liquid after 24 h and soft diet after 3 days, with no need for NGT feeding. The Clavien-Dindo classification was used to categorize surgical complications [14]. According to the 2016 International Study Group for Pancreatic Fistula revised grading system [15], clinically meaningful grade B or C pancreatic leakage constitutes the definition of postoperative pancreatic fistula (POPF). The International Study Group of Pancreatic Surgery (ISGPS) established classification criteria for delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), and chyle leak [16–18]. Based on the state of the resection margin, complete radical resection was performed in three cases: if there was no microscopic evidence of cancer at a resection margin of less than 1 mm, the resection was classified as R0; if there was microscopic evidence of cancer at a resection margin of less than 1 mm, it was classified as R1; and if there was a strong positive margin, it was classified as R2. Mortality that occurs within three months of surgery, involving the hospitalization period after surgery, is referred to as surgical mortality. The clinicopathological features of the patients’ retrospective data on the preoperative, perioperative, and postoperative features were gathered. Some of the most common factors that were known about patients before and after surgery were age, sex, body mass index (BMI), comorbidities, ASHA score, obstructive jaundice, preoperative percutaneous transhepatic cholangial drainage (PTCD), tumor location, pathological type, largest tumor diameter, number of lymph nodes harvested, operation duration, estimated blood loss (EBL), and blood transfusion. Postoperative complications and the duration of hospital stay (LOS) were among the postoperative features. Intra-abdominal bleeding, chyle leakage, delayed gastric emptying (DGE), and clinically relevant postoperative pancreatic fistula (CR-POPF) are terms used by the International Study Group on Pancreatic Surgery (ISGPS) (9–12). Positioning the patient, placing the trocar, and docking The Da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was used to carry out the robotic procedures. The patients were placed in a supine 20 °reverse Trendelenburg position with their legs spread apart and a small inclination to the left. The assisting surgeon was positioned between the patient's legs. A 12-mm camera port was positioned below the umbilicus (Figure 1). Before docking, the scope was introduced to examine the abdominal cavity and rule out distant metastases after pneumoperitoneum induction. Subsequently, the robotic system was connected to the head of the patient. For R1 (the first robotic arm), an 8-mm trocar was positioned at the intersection of the left mid-clavicular line and the horizontal line of the umbilicus. The second robotic arm, R2, was positioned 2-3 cm below the ribs at the right anterior axillary line. R3 (the third robotic arm) and a 12-mm assistance trocar were positioned on the contralateral side, opposite to R1 and R2. Maintaining a spacing of 10–15 cm between neighboring robotic arms minimized the interference. To perform a preliminary pancreatic examination, the gastrocolic ligament was opened. The right transverse colon, mesocolon, and hepatic colonic flexure were moved downward so that the duodenum and pancreatic head could be clearly seen. After dividing the retropancreatic region, the superior mesenteric vein (SMV) was visible. The GCT or gastrocolic trunk was later ligated. A portion of the distal stomach was removed with the aid of 60-mm linear cutter staplers (Echelon, Johnson & Johnson, USA). The common hepatic artery (CHA) was visualized by dissecting the top margin of the pancreas. After ligating the gastroduodenal artery (GDA) and right gastric artery (RGA) at their roots, the portal vein (PV) was visible. After the gallbladder was removed, the hepatoduodenal ligament was skeletonized and the common hepatic duct was separated. The superior mesenteric artery (SMA) was exposed using the right posterior "artery-first" technique. To view the aorta (AA) and left renal vein (LRC), an extended Kocher maneuver was used to dissect, retract, and then reposition the duodenum and the pancreatic head medially. The dissection of the SMA was approximately 1 cm superior to the LRC. We decided to cut the inferior pancreaticoduodenal artery (IPDA) and separate the adhesion between the pancreatic uncinate process and SMA at the back. Subsequently, the pancreas was split cranially in the neck. Using a 60-mm linear cutter stapler, the proximal jejunum was separated and dragged into the right upper quadrant. The uncinate process was separated from the SMV and SMA during the last stage of the resection. The right posterior "SMA-first" dissection method resulted in a thinner uncinate process. To improve visualization during dissection of the uncinate process, the pancreatic head, duodenum, and SMV were retracted laterally with a 45–60° anticlockwise rotation and medially. The uncinate process was then divided cranially and longitudinally along the right aspect of the SMA. En bloc resection of the specimen was used to clear the right 180° of the SMA,with stenting of the pancreatic duct. The specimen was removed by a 5-cm curved periumbilical incision, and the robotic system was then redocked. A modified version of Child's approach was used to perform digestive repair. Our center performed a modified double-layer pancreaticojejunostomy using a duct-to-mucosa approach. The pancreatic remnant is 0.5 cm from the edge of the anastomosis and is a continuous suture with 4-0 prolene between the seromuscular layer of the jejunum. It can partially wrap the pancreatic stump after anastomosis. The inner layer is a duct-to-mucosa anastomosis that is sewn from the pancreatic stump edge to the major pancreatic duct (MPD) and jejunum's equivalent point. This technique removes any possible space between the pancreatic remnant and jejunum with improved attachment, preventing tears in the pancreatic duct and parenchyma. Duct-to-mucosa anastomosis frequently required six–eight stitches, and a trans-anastomotic stent was frequently inserted (as shown in figure 2). The common hepatic duct's width determined whether continuous or interrupted sutures were used during an end-to-side hepaticojejunostomy. Using a 60-mm linear cutter stapler (Echelon, Johnson & Johnson), gastrojejunostomy was performed using a side-to-side anastomosis approach between the posterior wall of the stomach and jejunum. Data statestics The Statistical Product and Service Solutions version 26 program was used to perform statistical analyses. Continuous variables were compared using a two-tailed Student's t-test and expressed as the mean ± standard deviation. Wilcoxon rank-sum test was used for continuous variables that were not normally distributed. Categorical variables are represented as numbers (percentages), and Pearson's χ2 test or Fisher's exact test contingency tables were used for comparison. The overall survival between the young and old groups was compared using Kaplan-Meier survival curves, and significance was assessed using the log-rank test. Cox proportional hazards regression and binary logistic regression were used for multivariate analysis. Statistical significance was set at P <0.05. Results Of the 1110 individuals in this investigation, 106 (9.5%) were in the youngest cohort (age <50), and 1004 (90.5%) were in the more elderly category (age ≥50) (Table 1). Regarding gender, BMI, or tumor size, it had no discernible differences in the demographics of any of the groups. On the other hand, more individuals in the younger group (9.4% vs. 38.0%, p < 0.001) were found to have an ASA physical status of ≥ 3. Youths had a lower prevalence of periampullary cancers (32.1% vs. 76.5%, p<0.001) compared to the old population. However, the incidence of neuroendocrine system malignancies (15.1% vs. 3.6%), as well as hard and pseudopapillary malignancies (9.4% vs. 1.0%), were greater in children. Both pancreatic head periampullary cancer (41.2% vs. 48.4%) and other forms (58.8% vs. 51.6%) of periampullary adenocarcinoma were found in an equivalent amount of people of both ages (p = 0.626). Smoother pancreatic tissue (77.4% vs. 62.5%, p = 0.033) and non-dilated ducts (≤3 mm) were more common in the youngest category (77.4% vs. 46.3%, p < 0.001). Table 1: The characteristics of individuals undergoing robotic pancreaticoduodenectomy with periampullary malignancies Total Age < 50 y/o Age ≥ 50 y/o P value Patients, n (%) 1110 106 (9.5%) 1004 (90.5%) Age, year old < 0.001 Median (range) 67 (13–97) 42 (13–49) 68 50–97) Mean ± SD a 66 ± 12 40 ± 9 69 ± 9 Sex 0.512 female 518 (46.7%) 54 (50.9%) 464 (46.2%) male 592 (53.3%) 52(49.1%) 540 (53.8%) BMI b , kg/m 2 0.628 Median (range) 23.5 (15.4–36.2) 23.1 (16.7–34.1) 23.5 (15.4–36.2) Mean ± SD 23.7 ± 3.5 23.9 ± 4.1 23.7 ± 3.4 ASA c physical status classification < 0.001 < 3 718 (64.7%) 96 (90.6%) 622 (62.0%) ≥ 3 392 (35.3%) 10 (9.4%) 382 (38.0%) Periampullary lesions < 0.001 Pancreatic head adenocarcinoma 386 (34.8%) 14 (13.2%) 372 (37.1%) Ampullary adenocarcinoma 278 (25.0%) 12 (11.3%) 266 (25.5%) Distal CBD d adenocarcinoma 86 (7.7%) 0 (0.0%) 86 (8.6%) Duodenal adenocarcinoma 52 (4.7%) 8 (7.5%) 44 (4.4%) IPMN e 86 (7.7%) 8 (7.5%) 78 (7.8%) Neuroendocrine tumor 26 (4.7%) 8 (15.1%) 18 (3.6%) Solid and pseudopapillary tumor 20 (1.8%) 10 (9.4%) 10 (1.0%) Chronic pancreatitis 16 (2.9%) 5 (9.4%) 11 (2.2%) Other malignant tumor 66 (5.9%) 14 (13.2%) 52 (5.2%) Other benign tumor 52 (4.7%) 14 (13.2%) 38 (3.8%) Periampullary adenocarcinomas < 0.001 Yes 802 (72.3%) 34 (32.1%) 768 (76.5%) No 308 (27.7%) 72 (57.9%) 236 (23.5%) Periampullary adenocarcinomas 0.626 Pancreatic head adenocarcinomas 386 (48.1%) 14 (41.2%) 372 (48.4%) Other periampullary adenocarcinoma 416 (51.9%) 20 (58.8%) 396 (51.6%) Pancreatic parenchyma 0.033 soft 710 (64.0%) 82 (77.4%) 628 (62.5%) hard 400 (36.0%) 24 (22.6%) 376 (37.5%) Pancreatic duct 3mm 556 (50.7%) 48 (22.6%) 532 (53.7%) Tumor size, cm 0.263 Median (range) 3.0 (0.5–11.0) 3.0 (1.0–8.5) 3.0 (0.5–11.0) Mean ± SD 3.1 ± 1.4 3.3 ± 1.7 3.1 ± 1.4 a SD: standard deviation; b BMI: body mass index; c ASA: American Society of Anesthesiologists; d CBD: common bile duct; e IPMN: intraductal papillary mucinous neoplasm Table 2 demonstrates that there were no significant variations between each of the ages groups' surgical outcomes in terms of the length of the procedure (median, 7.8 vs. 8.3 h; p = 0.508), hemorrhage during surgery (median, 100 vs. 160 mL; p = 0.681), performing radicality (R0 dissection, 92.5% vs. 85.1%; p = 0.217), lymph nodes generated (median, 17 vs. 18; p = 0.681), lymph nodes affected (50.0% vs. 56.1%, p = 0.798), phase 1 + 2 (58.8% vs. 70.6%, p = 0.292), percentage of conversion (5.7 vs. 8.4%, p = 0.492), and blood vessel removal rate (3.8% vs. 3.8%, p = 0.997). In the youngest cohort, the majority of surgical outcomes were favorable. With a median of 16 days, the LOS of the younger group was lower than that of the older cohort (median of 20 days; p = 0.033). Pancreatic head adenocarcinoma (+), morbidity (+), POPF (+), and chyle leakage (+) were revealed to be associated in a multivariate approach using binary logistic regression; nevertheless, aging did not serve as another marker of a prolonged hospitalizations period (PHP) under RPD (Fig. 3). Table 2 shows the outcomes of the robotic pancreaticoduodenectomy procedure. Total Age < 50 y/o Age ≥ 50 y/o P value Patients, n 1110 106 (9.5%) 1004 (90.5%) Operation time, hour 0.508 Median (range) 8.0 (3.3–16.3) 7.8 (4.0–13.5) 8.3 (3.3–16.3) Mean ± SD a 8.4 ± 2.3 7.9 ± 2.3 8.4 ± 2.3 Blood loss, c.c. 0.681 Median (range) 160 (0–6000) 100 (0–4600) 160 (0–6000) Mean ± SD 239 ± 396 261 ± 666 237 ± 357 Surgical radicality 0.217 R0 952 (85.8%) 98 (92.5%) 854 (85.1%) R1 114 (10.3%) 8 (7.5%) 106 (10.6%) R2 44 (4.0%) 0 44 (4.4%) Lymph node yield 0.351 Median (range) 18 (12–49) 17 (12–37) 18 (12–49) Mean ± SD 19 ± 6 18 ± 6 19 ± 5 Lymph node involvement 436 (55.9%) 16 (50.0%) 420 (56.1%) 0.798 Stage 0.292 1 + 2 562 (70.1% 20 (58.8%) 709 (70.6%) 3 + 4 240 (29.9%) 14 (41.2%) 226 (29.4%) Conversion to open, n (%) 90 (8.1%) 6 (5.7%) 84 (8.4%) 0.492 Vascular resection, n (%) 420 (3.8%) 4 (3.8%) 38 (3.8%) 0.997 LOS b , day 0.033 Median (range) 19 (6–118) 16 (6–46) 20 (6–118) Mean ± SD 23 ± 14 19 ± 9 23 ± 14 a SD: standard deviation; b LOS: length of stay Figure 3 shows a forest diagram of multivariate analysis using a binary logistic regression approach. It shows how different factors were used to predict the length of hospitality (LOH) after a robotic pancreaticoduodenectomy. prolonged gastric empty (PGE), after-surgery pancreatic fistula (ASPF), confidence interval (CI), and US Association of Anesthesia Professionals (AAP). The total postoperative deaths remained at 1.5%, with 1.6% in the elderly cohort and no postoperative deaths in the youthful category (p = 0.352). DGE rates were 4.3% for all individuals: 1.9% for the younger population and 4.6% for the more elderly cohort (P = 0.359). The total POPF percentage reached 7.9% (P = 0.914), including 7.5% in the youthful category and 8.0% in the elderly cohort. Furthermore, Table 3 shows that there were no significant variations in postoperative illness, Clavien-Dindo surgical complications, issue seriousness, PPH, chyle leaking, biliary leaks, or infection from wounds among the more youthful and older generations. Table 3: The hazards related to operations after robotic pancreaticoduodenectomy Total Age < 50 y/o Age ≥ 50 y/o P value Patients, n 1110 106 (9.5%) 1004 (90.5%) Surgical mortality 16 (1.5%) 0 16 (1.6%) 0.352 Surgical morbidity 624 (56.2%) 56 (52.8%) 568 (56.6%) 0.601 Surgical complication 0.888 Clavien–Dindo 0 472 (42.5%) 46 (43.4%) 426 (42.4%) Clavien–Dindo I 282 (34.4%) 36 (34.0%) 146 (34.5%) Clavien–Dindo II 104 (9.4%) 10 (9.4%) 54 (9.4%) Clavien–Dindo III 122 (11.2%) 14 (13.2%) 110 (11.0%) Clavien–Dindo IV 10 (0.9%) 0 10 (1.0%) Clavien–Dindo V (death) 18 (1.6%) 0 18 (1.8%) Severity of complication, n = 319 0.947 Minor (Clavien–Dindo I-II) 486 (76.2%) 46 (76.7%) 440 (76.1%) Major (Clavien–Dindo ≥ III) 152 (23.8%) 14 (23.3%) 138 (23.9%) POPF a (ISGPF b grade B and C) Overall 88 (7.9%) 8 (7.5%) 80 (8.0%) 0.914 Parenchyma of pancreas soft 74 (10.4%) 8 (9.8%) 66 (10.5%) 0.882 hard 14 (3.5%) 0 14 (3.7%) 0.496 Diameter of pancreatic duct non-dilated ≤ 3 mm 60 (11.1%) 8 (9.8%) 52 (11.4%) 0.746 dilated > 3 mm 28 (5.0%) 0 28 (5.3%) 0.415 DGE c (ISGPS d grade B and C) 48 (4.3%) 2 (1.9%) 46 (4.6%) 0.359 PPH e (ISGPS d grade B and C) 64 (5.8%) 8 (7.5%) 56 (5.6%) 0.559 Chyle leakage 280 (25.2%) 28 (26.4%) 252 (25.1%) 0.834 Bile leakage 20 (1.8%) 2 (1.9%) 18 (1.8%) 0.961 Wound infection 56 (5.0%) 2 (1.9%) 54 (5.4%) 0.269 a POPF: postoperative pancreatic fistula, b ISGPF: International Study Group of Pancreatic Fistula; c DGE: delayed gastric emptying; d ISGPS: International Study Group of Pancreatic Surgery; e PPH: postpancreatectomy hemorrhage In terms of surviving, Table 4 shows that 48.1% of the population with periampullary adenocarcinomas lived for an average of five years. The more young category's 5-year survival probability for periampullary adenocarcinoma was significantly greater compared with the more elderly category's (76.4% vs. 46.7%, p = 0.047) (Fig. 4). Ampullary and pancreatic head adenocarcinomas had 5-year longevity of 100% and 61.4% (p = 0.159) and 62.5% and 31.4% (p = 0.171), respectively. Regarding the likelihood of survival, overall there had been no apparent distinction across both categories. The Cox proportional hazards regression framework (Fig. 5) demonstrated that inadequate longevity following robotic pancreaticoduodenectomy wasn't significantly predicted by age. On the other hand, late stage 3+4 (+), lymphatic node (LN) involvement (+), and pancreatic head malignancy (+) had been noted. Table 4: Survival rates following robotic pancreaticoduodenectomy for periampullary adenocarcinomas Periampullary adenocarcinoma Median, (mon.) Range, (mon.) Mean ± SD a , (mon.) 1-year survival 3-year survival 5-year survival P value Overall periampullary Total, n = 394 20.4 0.2–107.6 28.7 + 23.3 85.4% 57.1% 48.1% 0.047 Age < 50 y/o, n = 17 35.3 8.9–82.9 40.1 ± 24.2 100% 76.4% 76.4% Age ≥ 50 y/o, n = 377 20.2 0.2–107.6 28.2 ± 23.2 84.7% 56.2% 46.7% Pancreatic head Total, n = 191 16.6 0.8–98.1 23.0 ± 19.8 77.8% 40.4% 32.9% 0.171 Age < 50 y/o, n = 7 24.6 8.9–67.3 34.4 ± 22.4 100% 62.5% 62.5% Age ≥ 50 y/o, n = 184 16.5 0.8–98.1 22.6 ± 19.6 76.9% 39.4% 31.4% Ampullary Total, n = 136 28.1 0.2–107.6 35.7 ± 26.3 91.3% 73.9% 63.1% 0.159 Age < 50 y/o, n = 6 43.4 11.7–75.6 41.9 ± 29.0 100% 100% 100% Age ≥ 50 y/o, n = 130 28.1 0.2–107.6 35.7 ± 26.3 90.9% 72.8% 61.4% a SD: standard deviation; Discussion Given that less than 30% of tumors are projected to arise in young people, pancreatic cancer and In contrast to older individuals, younger individuals are less likely to have additional periampullary cancers [19]. This is particularly valid regarding periampullary malignancies such as pancreatic tumors. Cancers in youngsters may not be identical to those that occur in older people with respect to their molecular makeup and tumor biology. Our present knowledge of cancer in this demographic is limited, notwithstanding the ongoing discussion concerning whether or not patients who are younger have less favorable outcomes than patients who are older [2]. The use of MIS is becoming more widespread. However, there wasn't much study done on how early age affects survival and operation following RPD. In comparison to the older category, periampullary adenocarcinomas were less prevalent in the youthful cohort (32.1% vs. 76.5%). On the other hand, neuroendocrine tumors (15.1% vs. 3.6%), as well as hard and pseudopapillary masses (9.4% vs. 1.0%), were more common in the group that was younger. Mansfield et al. [20] found that the most prevalent postoperative histologic description following pancreaticoduodenectomy in young individuals (≤ 30 years old) was chronic pancreatitis (6, 27.3%), next to substantial pseudopapillary cancers (22.7%) and adenocarcinomas (18.2%). El Nakeeb et al. [1] reported a case series of young adults (less than 35 years old) who had pancreaticoduodenectomy. The most prevalent diagnostic category in this group, according to findings, was adenocarcinoma (41.4%), followed by hard pseudopapillary malignancies (29.3%). Although the most common diagnoses reported in the literature are inconsistent, solid pseudopapillary tumors have become a common histological diagnosis in young individuals. Younger people may be more susceptible to pancreatic leakage because they often have a smaller pancreatic duct, a less fibrotic pancreas, and a more normal pancreatic parenchyma. As predicted, the prevalence of non-dilated (<3 mm) pancreatic ducts and soft pancreatic parenchyma was higher in the younger group (77.4% vs. 62.5% and 77.4% vs. 46.3%, respectively). Despite these variations, the younger group did not have an increase in POPF or surgical complications compared with the older group. Furthermore, there was no surgical mortality in the younger group, supporting the findings of other studies [1, 5, 20] that RPD are safe for young patients. Although the youth group in this study had a shorter LOS (median, 16 vs. 20 days), age by itself was not an independent predictor of LOS following multivariate analysis. Most likely, reduced morbidity, lower POPF, and fewer cases of pancreatic head adenocarcinoma contributed to the shorter LOS in younger patients. There is ongoing discussion regarding the relative aggressiveness of younger versus older patients with pancreatic duct adenocarcinomas [2–5]. Meng et al. [5] found no significant correlation between age and long-term survival in patients with pancreatic and periampullary adenocarcinomas after LPD. Additionally, Yeh et al. [21] demonstrated that statistical longevity after pancreaticoduodenectomy varied among individuals of different ages. Many experts have suggested that elderly people's cancer may be biologically harmless [22, 23]. As such, youthful cancer sufferers are thought to possess less favorable outcomes compared to those who are older [24–27]. Applying propensity score matching, Tang et al. [2] evaluated teens and young adults following a radical removal of pancreatic ductal adenocarcinoma and found that cancer might be more serious in those years. Furthermore, Mansfield et al. [20] discovered that the median survival for those with juvenile adenocarcinoma was 10.2 months, while the same mortality for adult patients was 57.8 months. Contrary to Tang and Mansfield's observations [2, 20], El Nakeeb et al. [1] showed that the median survival of young adult patients with pancreatic cancer was much higher than that of older individuals. For overall periampullary adenocarcinoma in this study, young people did five years better than the older individuals (76.4% vs. 46.7%). While the disparity did not prove statistically important, there was indeed an upward trend favoring greater survival prospects in younger patients in the two different ampullary and pancreatic head adenocarcinoma categories. In the multivariate study, aging did not prove to be a distinct indicator of periampullary adenocarcinoma. This could be a result of the smaller number of pancreatic head cancer cases with the presence of lymph nodes in our analysis. Still, drawing obvious inferences was challenging due to the more youthful group's tiny sampling size. Further investigation and larger numbers of samples are needed to confirm these findings and understand the mechanisms behind them. This research has several restrictions. Initially, older individuals comprised all patients in adulthood, regardless of their general health status or comorbidity. In addition, the insufficient number of samples in this young group limited our ability to fully understand biological aggressiveness and increased the likelihood of statistical mistakes. In conclusion RPD is safer for people below 50, and surgery outcomes will be comparable to those in elderly patients. Furthermore, younger individuals with periampullary adenocarcinoma had significantly improved chances of survival than those who were older, despite the fact that the data were not autonomous. These findings support the feasibility and potential benefits of RPD in the pediatric population. A larger number of samples and additional research are needed to confirm these findings and look into the reasons for them. Declarations Acknowledgment is not applicable Ethical approved and conse nt All necessary ethical licences were issued by the Zagazig University's ethical board committees (ZUM -IRB#99902792023) with written informed consent. Written informed consent obatined from all patients and the study was conducted in accordance with the Helsinki Declaration Consent for publication is not applicable Availability of data and materials: a database is available to the corresponding author. This database is available for review and request. All authors have agreed and shared the database. Competing interests The authors declare that they have no competing interests or financial disclosures. Funding No specific funds were received for this study Authors Affilatiion Hassan A. Saad¹, Azza Baz², Mohamed Riad¹, Mohamed E Eraky¹, Ahmed El-Taher¹, Mohamed I Farid¹, Khaled Sharaf¹ ¹Surgical Department, Faculty of Medicine, Zagazig University, Zagazig City, Sharquia, Egypt. ²Surgical Department, Alahrar Teaching Hospital, Zagazig City,Sharquia, Egypt Corresponding author: Hassan A. Saad, Telephone: (+20) 01221025689, ORCID:0000-0002-6242-7823. E-mail: [email protected] Author contributions HAS, ME: contributed to the conception and design of MR, AKE: organised the database and performed the statistical analysis. HAS,KS: wrote sections of the manuscript and prepared tables. MIF, AB contributed to the manuscript. revision. All authors read, approved, and equally shared the submitted version Authors information Authors' email and billingaddresses Hassan A. Saad : -1 [email protected] Zagagic City, Sharquia 12 Saad Zagloul, St. Egypt Corresponding author Postcode (PC): 44661 01221025689 Azza Baz-2 [email protected] Zagagic City, Sharquia, Egypt, 13 Kawmia St. Post code 55971 01226534689 Mohamed Riad -3 [email protected] Zagagagic City, Sharquia, Egypt ,13 orbi st Post code 55971 01277438642 Mohamed E Eraky-4 [email protected] 52 reiad St. Post code 55971 01019598000 Ahmed k El-Taher-5 [email protected] Zagagic City, Sharquia, Egypt, 13 Kawmia St. Post code 55971 01226534689 Mohamed I Farid -6 [email protected] Zagagic City, Sharquia, Egypt, 13 Kawmia St. Post code 55971 01226534689 Khaled Sharaf-6 [email protected] Zagagic City, Sharquia, Egypt, 25 Kawmia St. Post code 55971 01019754434 References El Nakeeb A, El Sorogy M, Salem A, Said R, El Dosoky M, Moneer A, Abdelwahab Ali M, Mahdy Y (2017) Surgical outcomes of pancreaticoduodenectomy in young patients: A case series. 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J Surg Res 204:232–236 Yeh CC, Jeng YM, Ho CM, Hu RH, Chang HP, Tien YW (2010) Survival after pancreaticoduodenectomy for ampullary cancer is not affected by age. World J Surg 34:2945–2952 Fisher CJ, Egan MK, Smith P, Wicks K, Millis RR, Fentiman IS (1997) Histopathology of breast cancer in relation to age. Br J Cancer 75:593–596 Monson K, Litvak DA, Bold RJ (2003) Surgery in the aged population: surgical oncology. Arch Surg 138:1061–1067 Cho SJ, Yoon JH, Hwang SS, Lee HS (2007) Do young hepatocellular carcinoma patients with relatively good liver function have poorer outcomes than elderly patients? J Gastroenterol Hepatol 22:1226–1231 Emile SH, Elfeki H, Shalaby M, Elbalka S, Metwally IH, Abdelkhalek M (2020) Patients with early-onset rectal cancer aged 40 year or less have similar oncologic outcomes to older patients despite presenting in more advanced stage; A retrospective cohort study. Int J Surg 83:161–168 Llanos O, Butte JM, Crovari F, Duarte I, Guzmán S (2006) Survival of young patients after gastrectomy for gastric cancer. World J Surg 30:17–20 Nakamura R, Saikawa Y, Takahashi T, Takeuchi H, Asanuma H, Yamada Y, Kitagawa Y (2011) Retrospective analysis of prognostic outcome of gastric cancer in young patients. Int J Clin Oncol 16:328–334 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3410686","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":238211808,"identity":"c3958b2b-75d4-413b-b9af-c95e77acd7e0","order_by":0,"name":"Hassan A. Saad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBAC+xlQBj8zY8OBDwwMCQS1GEhAGZLtzY0PZ5CkxeDM8WZjHqK0SPc+/HSjoo6B4UZim7Rtm10eP3sD44ePObi12MscN5bOOXOYgXEGUEtuW3KxZM8BZsmZ2/A5LI0BqPIAA7MEWAtz4oYbCWzMvPi1MP/ObatjYANpsWyrJ0oLG8hwBh6eg83GjG2HidAic4zNGuQXCfbGxoc9544nzuw52IzXL/az25hv5wBDzP4w+4MDP8qqE/vZmw9++IhHCwzUN4BIRjYw2UBYPQL8IUXxKBgFo2AUjBQAAGOYUcN1YDelAAAAAElFTkSuQmCC","orcid":"","institution":"Zagazig University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hassan","middleName":"A.","lastName":"Saad","suffix":""},{"id":238211809,"identity":"38145fc4-1289-44b0-9228-25ae9de33709","order_by":1,"name":"Azza Baz","email":"","orcid":"","institution":"Alahrar Teaching Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Azza","middleName":"","lastName":"Baz","suffix":""},{"id":238211810,"identity":"83643c05-1574-4c29-bcf9-d557c5834780","order_by":2,"name":"Mohamed Riad","email":"","orcid":"","institution":"Zagazig University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Riad","suffix":""},{"id":238211812,"identity":"c18e6b7d-0e40-4932-8449-49c9de5a5e54","order_by":3,"name":"Mohamed E Eraky","email":"","orcid":"","institution":"Zagazig University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"E","lastName":"Eraky","suffix":""},{"id":238211813,"identity":"e541af5f-7c16-4004-8214-a1b59466415f","order_by":4,"name":"Ahmed K El-Taher","email":"","orcid":"","institution":"Zagazig University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"K","lastName":"El-Taher","suffix":""},{"id":238211817,"identity":"66748339-8a90-48cc-a214-96e4206aa928","order_by":5,"name":"Mohamed I Farid","email":"","orcid":"","institution":"Zagazig University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"I","lastName":"Farid","suffix":""},{"id":238211818,"identity":"95808359-128d-465e-a7d7-d2c44db01ad2","order_by":6,"name":"Khaled Sharaf","email":"","orcid":"","institution":"Zagazig University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Khaled","middleName":"","lastName":"Sharaf","suffix":""}],"badges":[],"createdAt":"2023-10-04 13:44:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3410686/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3410686/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":44390720,"identity":"8927c72d-4540-4019-a6ed-e447cc150288","added_by":"auto","created_at":"2023-10-10 20:20:39","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35862,"visible":true,"origin":"","legend":"\u003cp\u003eRobotic pancreaticoduodenectomy (RPD) trocar placements R1, the first robotic arm; R2, the second robotic arm; C, the camera port; A, the assistant port; and R3, the third robotic arm.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3410686/v1/39c6ce62ec1effab5232c34b.jpg"},{"id":44390721,"identity":"06b8205a-6c03-4950-b649-5c0a640d3f30","added_by":"auto","created_at":"2023-10-10 20:20:39","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":48241,"visible":true,"origin":"","legend":"\u003cp\u003erobotic pancreaticodouenectomy with stenting\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3410686/v1/84a6fbe26614689206e4d27e.jpg"},{"id":44390722,"identity":"4bbf28a4-cf45-48b9-9b1e-492e390fe342","added_by":"auto","created_at":"2023-10-10 20:20:39","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47037,"visible":true,"origin":"","legend":"\u003cp\u003eBlot showing multivariate analysis using binary logistic regression.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3410686/v1/19cb4eaf1c6c36058225ca37.jpg"},{"id":44390723,"identity":"ef322b23-d870-4053-8987-ad6ec506c126","added_by":"auto","created_at":"2023-10-10 20:20:39","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":20301,"visible":true,"origin":"","legend":"\u003cp\u003eActuarial survival curves following robotic pancreaticoduodenectomy for the young (age \u0026lt;50 years) and old (age ≥50 years) groups with periampullary cancer.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3410686/v1/3d34adeb704dea08db0c4e5b.jpg"},{"id":44390724,"identity":"0d3e0f1d-926e-4e9f-8044-048c87d347ce","added_by":"auto","created_at":"2023-10-10 20:20:39","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":34408,"visible":true,"origin":"","legend":"\u003cp\u003esurvival identify independent prognostic factors. Lymph node: LN.after robotic. pancreaticoduodenectomy, we used the Cox proportional hazards regression model and the forest plot\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3410686/v1/b42c475d1a48c1f08aaaa6b1.jpg"},{"id":45277893,"identity":"3fdb4ab4-855d-4590-a528-d083cf2250f4","added_by":"auto","created_at":"2023-10-26 17:37:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":497900,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3410686/v1/f5d3c7df-5eea-4567-bcac-9dc17959950e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSafety and hazards of middle-life robotic pancreaticoduodenectomy\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eComplex and challenging pancreaticoduodenectomy, sometimes called the \u0026quot;Whipple operation,\u0026quot; is typically performed in elderly patients with pancreatic cancer and periampullary diseases. Younger patients rarely undergo pancreaticoduodenectomy, and the impact of age on surgical and survival outcomes remains unclear [1].\u003c/p\u003e\n\u003cp\u003ePatients in their 30s or 40s are rarely found to have pancreatic duct adenocarcinoma, which is often detected in patients aged 65\u0026ndash;75 years of age [2, 3]. The influence of youth on surgical and survival outcomes following pancreaticoduodenectomy has not been thoroughly investigated given its uncommon occurrence in younger patients. There is limited literature in this field [1, 2, 4, 5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTraditionally, an open technique is used to perform pancreaticoduodenectomy using a high abdominal incision, right saber slash, or lengthy upper midline incision. This leads to severe pain and, sometimes, even negative outcomes [6]. Minimally invasive surgery (MIS) has become the norm in several specialties, including pancreatic resection, owing to reduced pain, improved cosmesis, and smaller incisions. According to certain findings, older people can have laparoscopic pancreaticoduodenectomy (LPD) with good results [7\u0026ndash;9]. However, pancreaticoduodenectomy entails precise identification of the vital vascular anatomy, considerable dissection and removal of visceral organs, and technically challenging repair. As a result, minimally invasive pancreaticoduodenectomy is not widely used [10]. In light of the limits of laparoscopic surgery, the possibility of automated surgery has lately surfaced, thanks to the introduction of the Intelligent Surgical\u0026reg; da Vinci Robotic Surgical Machine (Sunnyvale, California, USA). With the use of this sort of technology, surgeons can perform tremor-free operations with their instruments and cameras, monitor the surgical region in three dimensions with higher resolution, and increase their range of motion by using endoscopes that mirror open surgical techniques.\u003c/p\u003e\n\u003cp\u003eAlthough these improvements improve flexibility, reduce tiredness in surgeons, and improve design, they are not as widely employed due to their substantial medical expenses and lack of operator expertise [10, 11]. Despite its sluggish adoption, numerous research investigations have shown that robotic pancreaticoduodenectomy (RPD) is a secure and feasible approach when contrasted with laparotomy [6, 10, 12, 13].\u003c/p\u003e\n\u003cp\u003eThere\u0026apos;s a dearth of studies on pancreaticoduodenectomy in patients who are younger; therefore, most of the available data on the results of surgery and therapeutic options originates from investigations of older people. Consequently, it is uncertain how cancer biology and treatment results vary between both elderly and younger populations. RPD in younger demographics has not been the subject of any studies yet. Our research evaluated a younger participant population (less than 50 years old) receiving RPD at our facility with an older patient cohort (\u0026gt; 50 years old) undergoing RPD in order to gain insight into the clinicopathological features, surgery-related results, and longevity results of these young individuals.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003e\u003cstrong\u003ePatient Choice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included patients who underwent RPD at 7 surgical institutes \u0026nbsp;between \u0026nbsp; January 2012 and October 2023, and data were collected \u0026nbsp;at our institute; 74 cases later, the learning curve for the RPD was surmounted. The first RPD was completed in January 2012.\u003c/p\u003e\n\u003cp\u003eThe patients were divided into two categories based on age: young (less than 50 years) and old (\u0026gt; 50 years). Any patient with a history of surgery and marked adhesion \u0026gt; 2 cm, \u0026nbsp;especially in the upper part of the abdomen, was excluded from our study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData gathering\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data related to patient characteristics and tumor features were collected, and patients were classified physically by the American Society of Anesthesiologists (ASA). All Preoperative, intraoperative, and post operative morbidities were evaluated. The likelihood associated with surgery, such as fatality and different postoperative difficulties, was also evaluated. Incidence of periampullary adenocarcinoma death has also been reported.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim of\u003c/strong\u003e \u003cstrong\u003eStudy\u003c/strong\u003e \u003cstrong\u003eOutcomes :\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary aim of this study was to compare the safety and risks of our case categories. The secondary study goal was to compare survival between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eA brief internal stent was inserted for a small pancreatic duct measuring less than 3 mm, although pancreatic duct stents are not commonly employed. The same jejunal limb was then used for hepaticojejunostomy without stenting, with either continuous (for dilated) or interrupted \u0026nbsp; (for non dilated ducts) sutures. By carefully lowering the stomach, an extracorporeal technique was used to perform a hand-sewn gastrojejunostomy. The gastrojejunostomy was placed in framesocolic, antecolic, and antiperistaltic positions close to the umbilical region. When feasible, a restricted antrectomy was performed following right gastric artery bifurcation in patients with an ischemic pylorus, instead of attempting pylorus-preserving pancreaticoduodenectomy. Oral liquid after 24 h and soft diet after 3 days, with no need for NGT feeding.\u003c/p\u003e\n\u003cp\u003eThe Clavien-Dindo classification was used to categorize surgical complications [14]. According to the 2016 International Study Group for Pancreatic Fistula revised grading system [15], clinically meaningful grade B or C pancreatic leakage constitutes the definition of postoperative pancreatic fistula (POPF). The International Study Group of Pancreatic Surgery (ISGPS) established classification criteria for delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), and chyle leak [16\u0026ndash;18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the state of the resection margin, complete radical resection was performed in three cases: if there was no microscopic evidence of cancer at a resection margin of less than 1 mm, the resection was classified as R0; if there was microscopic evidence of cancer at a resection margin of less than 1 mm, it was classified as R1; and if there was a strong positive margin, it was classified as R2. Mortality that occurs within three months of surgery, involving the hospitalization period \u0026nbsp; after surgery, is referred to as surgical mortality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe clinicopathological features of the patients\u0026rsquo;\u003c/strong\u003e retrospective data on the preoperative, perioperative, and postoperative features were gathered. Some of the most common factors that were known about patients before and after surgery were age, sex, body mass index (BMI), comorbidities, ASHA score, obstructive jaundice, preoperative percutaneous transhepatic cholangial drainage (PTCD), tumor location, pathological type, largest tumor diameter, number of lymph nodes harvested, operation duration, estimated blood loss (EBL), and blood transfusion. Postoperative complications and the duration of hospital stay (LOS) were among the postoperative features. Intra-abdominal bleeding, chyle leakage, delayed gastric emptying (DGE), and clinically relevant postoperative pancreatic fistula (CR-POPF) are terms used by the International Study Group on Pancreatic Surgery (ISGPS) (9\u0026ndash;12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePositioning the patient, placing the trocar, and docking\u003c/p\u003e\n\u003cp\u003eThe Da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was used to carry out the robotic procedures. The patients were placed in a supine 20 \u0026deg;reverse Trendelenburg position with their legs spread apart and a small inclination to the left. The assisting surgeon was positioned between the patient\u0026apos;s legs. A 12-mm camera port was positioned below the umbilicus (Figure 1). Before docking, the scope was introduced to examine the abdominal cavity and rule out distant metastases after pneumoperitoneum induction. Subsequently, the robotic system was connected to the head of the patient. For R1 (the first robotic arm), an 8-mm trocar was positioned at the intersection of the left mid-clavicular line and the horizontal line of the umbilicus. The second robotic arm, R2, was positioned 2-3 cm below the ribs at the right anterior axillary line. R3 (the third robotic arm) and a 12-mm assistance trocar were positioned on the contralateral side, opposite to R1 and R2. Maintaining a spacing of 10\u0026ndash;15 cm between neighboring robotic arms minimized the interference.\u003c/p\u003e\n\u003cp\u003eTo perform a preliminary pancreatic examination, the gastrocolic ligament was opened. The right transverse colon, mesocolon, and hepatic colonic flexure were moved downward so that the duodenum and pancreatic head could be clearly seen. After dividing the retropancreatic region, the superior mesenteric vein (SMV) was visible. The GCT or gastrocolic trunk was later ligated. A portion of the distal stomach was removed with the aid of 60-mm linear cutter staplers (Echelon, Johnson \u0026amp; Johnson, USA). The common hepatic artery (CHA) was visualized by dissecting the top margin of the pancreas. After ligating the gastroduodenal artery (GDA) and right gastric artery (RGA) at their roots, the portal vein (PV) was visible. After the gallbladder was removed, the hepatoduodenal ligament was skeletonized and the common hepatic duct was separated. The superior mesenteric artery (SMA) was exposed using the right posterior \u0026quot;artery-first\u0026quot; technique. To view the aorta (AA) and left renal vein (LRC), an extended Kocher maneuver was used to dissect, retract, and then reposition the duodenum and the pancreatic head medially. The dissection of the SMA was approximately 1 cm superior to the LRC. We decided to cut the inferior pancreaticoduodenal artery (IPDA) and separate the adhesion between the pancreatic uncinate process and SMA at the back. Subsequently, the pancreas was split cranially in the neck. Using a 60-mm linear cutter stapler, the proximal jejunum was separated and dragged into the right upper quadrant. The uncinate process was separated from the SMV and SMA during the last stage of the resection. The right posterior \u0026quot;SMA-first\u0026quot; dissection method resulted in a thinner uncinate process. To improve visualization during dissection of the uncinate process, the pancreatic head, duodenum, and SMV were retracted laterally with a 45\u0026ndash;60\u0026deg; anticlockwise rotation and medially. The uncinate process was then divided cranially and longitudinally along the right aspect of the SMA. En bloc resection of the specimen was used to clear the right 180\u0026deg; of the SMA,with stenting of the pancreatic duct. The specimen was removed by a 5-cm curved periumbilical incision, and the robotic system was then redocked.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA modified version of Child\u0026apos;s approach was used to perform digestive repair. Our center performed a modified double-layer pancreaticojejunostomy using a duct-to-mucosa approach. The pancreatic remnant is 0.5 cm from the edge of the anastomosis and is a continuous suture with 4-0 prolene between the seromuscular layer of the jejunum. It can partially wrap the pancreatic stump after anastomosis. The inner layer is a duct-to-mucosa anastomosis that is sewn from the pancreatic stump edge to the major pancreatic duct (MPD) and jejunum\u0026apos;s equivalent point. This technique removes any possible space between the pancreatic remnant and jejunum with improved attachment, preventing tears in the pancreatic duct and parenchyma. Duct-to-mucosa anastomosis frequently required six\u0026ndash;eight stitches, and a trans-anastomotic stent was frequently inserted (as shown in figure 2). The common hepatic duct\u0026apos;s width determined whether continuous or interrupted sutures were used during an end-to-side hepaticojejunostomy. Using a 60-mm linear cutter stapler (Echelon, Johnson \u0026amp; Johnson), gastrojejunostomy was performed using a side-to-side anastomosis approach between the posterior wall of the stomach and jejunum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData statestics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Statistical Product and Service Solutions version 26 program was used to perform statistical analyses. Continuous variables were compared using a two-tailed Student\u0026apos;s t-test and expressed as the mean \u0026plusmn; standard deviation. Wilcoxon rank-sum test was used for continuous variables that were not normally distributed. Categorical variables are represented as numbers (percentages), and Pearson\u0026apos;s \u0026chi;2 test or Fisher\u0026apos;s exact test contingency tables were used for comparison. The overall survival between the young and old groups was compared using Kaplan-Meier survival curves, and significance was assessed using the log-rank test. Cox proportional hazards regression and binary logistic regression were used for multivariate analysis. Statistical significance was set at P \u0026lt;0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethe 1110 individuals in this investigation, 106 (9.5%) were in the youngest cohort (age \u0026lt;50), and 1004 (90.5%) were in the more elderly category (age \u0026ge;50) (Table 1). Regarding gender, BMI, or tumor size, it had no discernible differences in the demographics of any of the groups. On the other hand, more individuals in the younger group (9.4% vs. 38.0%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were found to have an ASA physical status of \u0026ge;\u0026thinsp;3. Youths had a lower prevalence of periampullary cancers (32.1% vs. 76.5%, p\u0026lt;0.001) compared to the old population. However, the incidence of neuroendocrine system malignancies (15.1% vs. 3.6%), as well as hard and pseudopapillary malignancies (9.4% vs. 1.0%), were greater in children. Both pancreatic head periampullary cancer (41.2% vs. 48.4%) and other forms (58.8% vs. 51.6%) of periampullary adenocarcinoma were found in an equivalent amount of people of both ages (p = 0.626). Smoother pancreatic tissue (77.4% vs. 62.5%, p = 0.033) and non-dilated ducts (\u0026le;3 mm) were more common in the youngest category (77.4% vs. 46.3%, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eThe characteristics of individuals undergoing robotic pancreaticoduodenectomy with periampullary malignancies\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;50 y/o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;50 y/o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePatients, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e1110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e106 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e1004 (90.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eAge, year old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e67 (13\u0026ndash;97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e42 (13\u0026ndash;49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e68 50\u0026ndash;97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e40\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e69\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e518 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e54 (50.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e464 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e592 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e52(49.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e540 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003csup\u003eb\u003c/sup\u003e, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e23.5 (15.4\u0026ndash;36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e23.1 (16.7\u0026ndash;34.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e23.5 (15.4\u0026ndash;36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eASA\u003csup\u003ec\u003c/sup\u003e physical status classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e718 (64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e96 (90.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e622 (62.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e392 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e10 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e382 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePeriampullary lesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePancreatic head adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e386 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e14 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e372 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eAmpullary adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e278 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e12 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e266 (25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eDistal CBD\u003csup\u003ed\u003c/sup\u003e adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e86 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e86 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eDuodenal adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e52 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e8 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e44 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eIPMN\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e86 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e8 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e78 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eNeuroendocrine tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e26 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e8 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e18 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eSolid and pseudopapillary tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e20 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e10 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e10 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eChronic pancreatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e16 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e5 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e11 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eOther malignant tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e66 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e14 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e52 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eOther benign tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e52 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e14 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e38 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePeriampullary adenocarcinomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e802 (72.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e34 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e768 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e308 (27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e72 (57.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e236 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePeriampullary adenocarcinomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePancreatic head adenocarcinomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e386 (48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e14 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e372 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eOther periampullary adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e416 (51.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e20 (58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e396 (51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePancreatic parenchyma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003esoft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e710 (64.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e82 (77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e628 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ehard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e400 (36.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e24 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e376 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003ePancreatic duct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003enon-dilated\u0026thinsp;\u0026le;\u0026thinsp;3 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e540 (49.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e82 (77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e458 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003edilated\u0026thinsp;\u0026gt;\u0026thinsp;3mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e556 (50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e48 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e532 (53.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eTumor size, cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e3.0 (0.5\u0026ndash;11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e3.0 (1.0\u0026ndash;8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e3.0 (0.5\u0026ndash;11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" valign=\"top\"\u003e\n \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.512820512820515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003csup\u003ea\u003c/sup\u003eSD: standard deviation; \u003csup\u003eb\u003c/sup\u003eBMI: body mass index; \u003csup\u003ec\u003c/sup\u003eASA: American Society of Anesthesiologists; \u003csup\u003ed\u003c/sup\u003eCBD: common bile duct; \u003csup\u003ee\u003c/sup\u003eIPMN: intraductal papillary mucinous neoplasm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 demonstrates that there were no significant variations between each of the ages groups\u0026apos; surgical outcomes in terms of the length of the procedure (median, 7.8 vs. 8.3 h; p = 0.508), hemorrhage during surgery (median, 100 vs. 160 mL; p = 0.681), performing radicality (R0 dissection, 92.5% vs. 85.1%; p = 0.217), lymph nodes generated (median, 17 vs. 18; p = 0.681), lymph nodes affected (50.0% vs. 56.1%, p = 0.798), phase 1 + 2 (58.8% vs. 70.6%, p = 0.292), percentage of conversion (5.7 vs. 8.4%, p = 0.492), and blood vessel removal rate (3.8% vs. 3.8%, p = 0.997). In the youngest cohort, the majority of surgical outcomes were favorable. With a median of 16 days, the LOS of the younger group was lower than that of the older cohort (median of 20 days; p = 0.033). Pancreatic head adenocarcinoma (+), morbidity (+), POPF (+), and chyle leakage (+) were revealed to be associated in a multivariate approach using binary logistic regression; nevertheless, aging did not serve as another marker of a prolonged hospitalizations period (PHP) under RPD (Fig. 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e shows the outcomes of the robotic pancreaticoduodenectomy procedure.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;50 y/o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;50 y/o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePatients, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e106 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1004 (90.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eOperation time, hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8.0 (3.3\u0026ndash;16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.8 (4.0\u0026ndash;13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8.3 (3.3\u0026ndash;16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eBlood loss, c.c.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e160 (0\u0026ndash;6000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e100 (0\u0026ndash;4600)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e160 (0\u0026ndash;6000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e239\u0026thinsp;\u0026plusmn;\u0026thinsp;396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e261\u0026thinsp;\u0026plusmn;\u0026thinsp;666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e237\u0026thinsp;\u0026plusmn;\u0026thinsp;357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical radicality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eR0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e952 (85.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e98 (92.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e854 (85.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eR1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e114 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e106 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eR2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e44 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e44 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eLymph node yield\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e18 (12\u0026ndash;49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e17 (12\u0026ndash;37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e18 (12\u0026ndash;49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e19\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e19\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eLymph node involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e436 (55.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e16 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e420 (56.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1\u0026thinsp;+\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e562 (70.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e20 (58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e709 (70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3\u0026thinsp;+\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e240 (29.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e226 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eConversion to open, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e90 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e84 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eVascular resection, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e420 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e38 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eLOS\u003csup\u003eb\u003c/sup\u003e, day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e19 (6\u0026ndash;118)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e16 (6\u0026ndash;46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e20 (6\u0026ndash;118)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e19\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eSD: standard deviation; \u003csup\u003eb\u003c/sup\u003eLOS: length of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eFigure 3 shows a forest diagram of multivariate analysis using a binary logistic regression approach. It shows how different factors were used to predict the length of hospitality (LOH) after a robotic pancreaticoduodenectomy. prolonged gastric empty (PGE), after-surgery pancreatic fistula (ASPF), confidence interval (CI), and US Association of Anesthesia Professionals (AAP).\u003c/p\u003e\n\u003cp\u003eThe total postoperative deaths remained at 1.5%, with 1.6% in the elderly cohort and no postoperative deaths in the youthful category (p = 0.352). DGE rates were 4.3% for all individuals: 1.9% for the younger population and 4.6% for the more elderly cohort (P = 0.359). The total POPF percentage reached 7.9% (P = 0.914), including 7.5% in the youthful category and 8.0% in the elderly cohort. Furthermore, Table 3 shows that there were no significant variations in postoperative illness, Clavien-Dindo surgical complications, issue seriousness, PPH, chyle leaking, biliary leaks, or infection from wounds among the more youthful and older generations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eThe hazards related to operations after robotic pancreaticoduodenectomy\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;50 y/o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;50 y/o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePatients, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e106 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1004 (90.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e16 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e16 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical morbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e624 (56.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e56 (52.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e568 (56.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eClavien\u0026ndash;Dindo 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e472 (42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e46 (43.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e426 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eClavien\u0026ndash;Dindo I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e282 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e36 (34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e146 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eClavien\u0026ndash;Dindo II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e104 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e10 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e54 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eClavien\u0026ndash;Dindo III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e122 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e110 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eClavien\u0026ndash;Dindo IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e10 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e10 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eClavien\u0026ndash;Dindo V (death)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e18 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e18 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eSeverity of complication, n\u0026thinsp;=\u0026thinsp;319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.947\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMinor (Clavien\u0026ndash;Dindo I-II)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e486 (76.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e46 (76.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e440 (76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eMajor (Clavien\u0026ndash;Dindo\u0026thinsp;\u0026ge;\u0026thinsp;III)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e152 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e138 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePOPF\u003csup\u003ea\u003c/sup\u003e (ISGPF\u003csup\u003eb\u003c/sup\u003e grade B and C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e88 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e80 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eParenchyma of pancreas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003esoft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e74 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e66 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ehard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eDiameter of pancreatic duct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003enon-dilated\u0026thinsp;\u0026le;\u0026thinsp;3 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e60 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e52 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003edilated\u0026thinsp;\u0026gt;\u0026thinsp;3 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e28 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e28 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eDGE\u003csup\u003ec\u003c/sup\u003e (ISGPS\u003csup\u003ed\u003c/sup\u003e grade B and C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e46 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePPH\u003csup\u003ee\u003c/sup\u003e (ISGPS\u003csup\u003ed\u003c/sup\u003e grade B and C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e64 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e56 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.559\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eChyle leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e280 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e28 (26.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e252 (25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eBile leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e20 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e18 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.961\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eWound infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e56 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e54 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003ePOPF: postoperative pancreatic fistula, \u003csup\u003eb\u003c/sup\u003eISGPF: International Study Group of Pancreatic Fistula; \u003csup\u003ec\u003c/sup\u003eDGE: delayed gastric emptying; \u003csup\u003ed\u003c/sup\u003eISGPS: International Study Group of Pancreatic Surgery; \u003csup\u003ee\u003c/sup\u003ePPH: postpancreatectomy hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of surviving, Table 4 shows that 48.1% of the population with periampullary adenocarcinomas lived for an average of five years. The more young category\u0026apos;s 5-year survival probability for periampullary adenocarcinoma was significantly greater compared with the more elderly category\u0026apos;s (76.4% vs. 46.7%, p = 0.047) (Fig. 4). Ampullary and pancreatic head adenocarcinomas had 5-year longevity of 100% and 61.4% (p = 0.159) and 62.5% and 31.4% (p = 0.171), respectively. Regarding the likelihood of survival, overall there had been no apparent distinction across both categories. The Cox proportional hazards regression framework (Fig. 5) demonstrated that inadequate longevity following robotic pancreaticoduodenectomy wasn\u0026apos;t significantly predicted by age. On the other hand, late stage 3+4 (+), lymphatic node (LN) involvement (+), and pancreatic head malignancy (+) had been noted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Survival rates following robotic pancreaticoduodenectomy for periampullary adenocarcinomas\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriampullary\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eadenocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(mon.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(mon.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003ea\u003c/sup\u003e,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(mon.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-year\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esurvival\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-year\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esurvival\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5-year\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esurvival\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eOverall periampullary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTotal, n\u0026thinsp;=\u0026thinsp;394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u0026ndash;107.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e28.7\u0026thinsp;+\u0026thinsp;23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e85.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e57.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e48.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;50 y/o, n\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e8.9\u0026ndash;82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e76.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e76.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;50 y/o, n\u0026thinsp;=\u0026thinsp;377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u0026ndash;107.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e84.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e56.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e46.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003ePancreatic head\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTotal, n\u0026thinsp;=\u0026thinsp;191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.8\u0026ndash;98.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e77.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e40.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e32.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;50 y/o, n\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e8.9\u0026ndash;67.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e34.4\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e62.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e62.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;50 y/o, n\u0026thinsp;=\u0026thinsp;184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.8\u0026ndash;98.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e22.6\u0026thinsp;\u0026plusmn;\u0026thinsp;19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e76.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e39.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e31.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAmpullary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTotal, n\u0026thinsp;=\u0026thinsp;136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u0026ndash;107.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e35.7\u0026thinsp;\u0026plusmn;\u0026thinsp;26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e91.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e73.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e63.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;50 y/o, n\u0026thinsp;=\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e43.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e11.7\u0026ndash;75.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e41.9\u0026thinsp;\u0026plusmn;\u0026thinsp;29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;50 y/o, n\u0026thinsp;=\u0026thinsp;130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u0026ndash;107.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e35.7\u0026thinsp;\u0026plusmn;\u0026thinsp;26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e90.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e72.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e61.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eSD: standard deviation;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eGiven that less than 30% of tumors are projected to arise in young people, pancreatic cancer and In contrast to older individuals, younger individuals are less likely to have additional periampullary cancers [19]. This is particularly valid regarding periampullary malignancies such as pancreatic tumors. Cancers in youngsters may not be identical to those that occur in older people with respect to their molecular makeup and tumor biology. Our present knowledge of cancer in this demographic is limited, notwithstanding the ongoing discussion concerning whether or not patients who are younger have less favorable outcomes than patients who are older [2]. The use of MIS is becoming more widespread. However, there wasn\u0026apos;t much study done on how early age affects survival and operation following RPD.\u003c/p\u003e\n\u003cp\u003eIn comparison to the older category, periampullary adenocarcinomas were less prevalent in the youthful cohort (32.1% vs. 76.5%). On the other hand, neuroendocrine tumors (15.1% vs. 3.6%), as well as hard and pseudopapillary masses (9.4% vs. 1.0%), were more common in the group that was younger. Mansfield et al. [20] found that the most prevalent postoperative histologic description following pancreaticoduodenectomy in young individuals (\u0026le; 30 years old) was chronic pancreatitis (6, 27.3%), next to substantial pseudopapillary cancers (22.7%) and adenocarcinomas (18.2%). El Nakeeb et al. [1] reported a case series of young adults (less than 35 years old) who had pancreaticoduodenectomy. The most prevalent diagnostic category in this group, according to findings, was adenocarcinoma (41.4%), followed by hard pseudopapillary malignancies (29.3%).\u003c/p\u003e\n\u003cp\u003eAlthough the most common diagnoses reported in the literature are inconsistent, solid pseudopapillary tumors have become a common histological diagnosis in young individuals. \u003c/p\u003e\n\u003cp\u003eYounger people may be more susceptible to pancreatic leakage because they often have a smaller pancreatic duct, a less fibrotic pancreas, and a more normal pancreatic parenchyma. As predicted, the prevalence of non-dilated (\u0026lt;3 mm) pancreatic ducts and soft pancreatic parenchyma was higher in the younger group (77.4% vs. 62.5% and 77.4% vs. 46.3%, respectively). Despite these variations, the younger group did not have an increase in POPF or surgical complications compared with the older group. Furthermore, there was no surgical mortality in the younger group, supporting the findings of other studies [1, 5, 20] that RPD are safe for young patients. Although the youth group in this study had a shorter LOS (median, 16 vs. 20 days), age by itself was not an independent predictor of LOS following multivariate analysis. Most likely, reduced morbidity, lower POPF, and fewer cases of pancreatic head adenocarcinoma contributed to the shorter LOS in younger patients. \u003c/p\u003e\n\u003cp\u003eThere is ongoing discussion regarding the relative aggressiveness of younger versus older patients with pancreatic duct adenocarcinomas [2\u0026ndash;5]. Meng et al. [5] found no significant correlation between age and long-term survival in patients with pancreatic and periampullary adenocarcinomas after LPD. Additionally, Yeh et al. [21] demonstrated that statistical longevity after pancreaticoduodenectomy varied among individuals of different ages. Many experts have suggested that elderly people\u0026apos;s cancer may be biologically harmless [22, 23]. As such, youthful cancer sufferers are thought to possess less favorable outcomes compared to those who are older [24\u0026ndash;27]. Applying propensity score matching, Tang et al. [2] evaluated teens and young adults following a radical removal of pancreatic ductal adenocarcinoma and found that cancer might be more serious in those years. Furthermore, Mansfield et al. [20] discovered that the median survival for those with juvenile adenocarcinoma was 10.2 months, while the same mortality for adult patients was 57.8 months. Contrary to Tang and Mansfield\u0026apos;s observations [2, 20], El Nakeeb et al. [1] showed that the median survival of young adult patients with pancreatic cancer was much higher than that of older individuals. For overall periampullary adenocarcinoma in this study, young people did five years better than the older individuals (76.4% vs. 46.7%). While the disparity did not prove statistically important, there was indeed an upward trend favoring greater survival prospects in younger patients in the two different ampullary and pancreatic head adenocarcinoma categories. In the multivariate study, aging did not prove to be a distinct indicator of periampullary adenocarcinoma. This could be a result of the smaller number of pancreatic head cancer cases with the presence of lymph nodes in our analysis. Still, drawing obvious inferences was challenging due to the more youthful group\u0026apos;s tiny sampling size. Further investigation and larger numbers of samples are needed to confirm these findings and understand the mechanisms behind them.\u003cbr\u003e This research has several restrictions. Initially, older individuals comprised all patients in adulthood, regardless of their general health status or comorbidity. In addition, the insufficient number of samples in this young group limited our ability to fully understand biological aggressiveness and increased the likelihood of statistical mistakes.\u003c/p\u003e\n\u003cp\u003eIn conclusion\u003c/p\u003e\n\u003cp\u003eRPD is safer for people below 50, and surgery outcomes will be comparable to those in elderly patients. Furthermore, younger individuals with periampullary adenocarcinoma had significantly improved chances of survival than those who were older, despite the fact that the data were not autonomous. These findings support the feasibility and potential benefits of RPD in the pediatric population. A larger number of samples and additional research are needed to confirm these findings and look into the reasons for them.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment is\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approved and conse\u003c/strong\u003ent\u003c/p\u003e\n\u003cp\u003eAll necessary ethical licences were issued by the Zagazig University\u0026apos;s ethical board committees (ZUM -IRB#99902792023) with written informed consent. Written informed consent obatined from all patients and the study was conducted in accordance with the Helsinki Declaration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e is not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials: a\u003c/strong\u003e database is available to the corresponding author. This database is available for review and request. All authors have agreed and shared the database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests or financial disclosures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo specific funds were received for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Affilatiion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHassan A. Saad\u0026sup1;,\u003c/p\u003e\n\u003cp\u003eAzza Baz\u0026sup2;,\u003c/p\u003e\n\u003cp\u003eMohamed Riad\u0026sup1;,\u003c/p\u003e\n\u003cp\u003eMohamed E Eraky\u0026sup1;,\u003c/p\u003e\n\u003cp\u003eAhmed El-Taher\u0026sup1;,\u003c/p\u003e\n\u003cp\u003eMohamed I Farid\u0026sup1;,\u003c/p\u003e\n\u003cp\u003eKhaled Sharaf\u0026sup1;\u003c/p\u003e\n\u003cp\u003e\u0026sup1;Surgical Department, Faculty of Medicine, Zagazig University, Zagazig City, Sharquia, Egypt.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u0026sup2;Surgical Department, Alahrar Teaching Hospital, Zagazig City,Sharquia, Egypt\u003c/p\u003e\n\u003cp\u003eCorresponding author: Hassan A. Saad, Telephone: (+20) 01221025689, ORCID:0000-0002-6242-7823. E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHAS, ME: contributed to the conception and design of\u003c/p\u003e\n\u003cp\u003eMR, AKE: organised the database and performed the statistical analysis.\u003c/p\u003e\n\u003cp\u003eHAS,KS: wrote sections of the manuscript and prepared tables.\u003c/p\u003e\n\u003cp\u003eMIF, AB contributed to the manuscript. revision.\u003c/p\u003e\n\u003cp\u003eAll authors read, approved, and equally shared the submitted version\u003cbr\u003e\u003cbr\u003e\u003cstrong\u003eAuthors information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; email and billingaddresses\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHassan A. Saad\u003c/strong\u003e: -1\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003eZagagic City, Sharquia\u003c/p\u003e\n\u003cp\u003e12 Saad Zagloul, St. Egypt\u003c/p\u003e\n\u003cp\u003eCorresponding author\u003c/p\u003e\n\u003cp\u003ePostcode (PC): 44661\u003c/p\u003e\n\u003cp\u003e01221025689\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAzza Baz-2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003eZagagic City, Sharquia, Egypt,\u003c/p\u003e\n\u003cp\u003e13 Kawmia St.\u003c/p\u003e\n\u003cp\u003ePost code 55971\u003c/p\u003e\n\u003cp\u003e01226534689\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMohamed Riad\u003c/strong\u003e-3\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003eZagagagic City, Sharquia, Egypt\u003c/p\u003e\n\u003cp\u003e,13 orbi st\u003c/p\u003e\n\u003cp\u003ePost code 55971\u003c/p\u003e\n\u003cp\u003e01277438642\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMohamed E Eraky-4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003e52 reiad St.\u003c/p\u003e\n\u003cp\u003ePost code 55971\u003c/p\u003e\n\u003cp\u003e01019598000\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAhmed k El-Taher-5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003eZagagic City, Sharquia, Egypt,\u003c/p\u003e\n\u003cp\u003e13 Kawmia St.\u003c/p\u003e\n\u003cp\u003ePost code 55971\u003c/p\u003e\n\u003cp\u003e01226534689\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMohamed I Farid\u003c/strong\u003e-6\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003eZagagic City, Sharquia, Egypt,\u003c/p\u003e\n\u003cp\u003e13 Kawmia St.\u003c/p\u003e\n\u003cp\u003ePost code 55971\u003c/p\u003e\n\u003cp\u003e01226534689\u003c/p\u003e\n\u003cp\u003eKhaled Sharaf-6\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003eZagagic City, Sharquia, Egypt,\u003c/p\u003e\n\u003cp\u003e25 Kawmia St.\u003c/p\u003e\n\u003cp\u003ePost code 55971\u003c/p\u003e\n\u003cp\u003e01019754434\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEl Nakeeb A, El Sorogy M, Salem A, Said R, El Dosoky M, Moneer A, Abdelwahab Ali M, Mahdy Y (2017) Surgical outcomes of pancreaticoduodenectomy in young patients: A case series. Int J Surg 44:287\u0026ndash;294\u003c/li\u003e\n\u003cli\u003eTang N, Dou X, You X, Liu G, Ou Z, Zai H (2021) Comparisons of Outcomes Between Adolescent and Young Adult with Older Patients After Radical Resection of Pancreatic Ductal Adenocarcinoma by Propensity Score Matching: A Single-Center Study. Cancer Manag Res 13:9063\u0026ndash;9072\u003c/li\u003e\n\u003cli\u003eBarbas AS, Turley RS, Ceppa EP, Reddy SK, Blazer DG, 3rd, Clary BM, Pappas TN, Tyler DS, White RR, Lagoo SA (2012) Comparison of outcomes and the use of multimodality therapy in young and elderly people undergoing surgical resection of pancreatic cancer. J Am Geriatr Soc 60:344\u0026ndash;350\u003c/li\u003e\n\u003cli\u003eLiu Q, Zhao Z, Zhang X, Zhao G, Tan X, Gao Y, Lau WY, Liu R (2020) Robotic pancreaticoduodenectomy in elderly and younger patients: A retrospective cohort study. Int J Surg 81:61\u0026ndash;65\u003c/li\u003e\n\u003cli\u003eMeng L, Xia Q, Cai Y, Wang X, Li Y, Cai H, Peng B (2019) Impact of Patient Age on Morbidity and Survival Following Laparoscopic Pancreaticoduodenectomy. Surg Laparosc Endosc Percutan Tech 29:378\u0026ndash;382\u003c/li\u003e\n\u003cli\u003eShyr BU, Shyr BS, Chen SC, Shyr YM, Wang SE (2021) Mesopancreas level 3 dissection in robotic pancreaticoduodenectomy. Surgery 169:362\u0026ndash;368\u003c/li\u003e\n\u003cli\u003eKim JS, Choi M, Kim SH, Choi SH, Kang CM (2022) Safety and feasibility of laparoscopic pancreaticoduodenectomy in octogenarians. Asian J Surg 45:837\u0026ndash;843\u003c/li\u003e\n\u003cli\u003eChapman BC, Gajdos C, Hosokawa P, Henderson W, Paniccia A, Overbey DM, Gleisner A, Schulick RD, McCarter MD, Edil BH (2018) Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Surg Endosc 32:2239\u0026ndash;2248\u003c/li\u003e\n\u003cli\u003eJones LR, Zwart MJW, Molenaar IQ, Koerkamp BG, Hogg ME, Hilal MA, Besselink MG (2020) Robotic Pancreatoduodenectomy: Patient Selection, Volume Criteria, and Training Programs. Scand J Surg 109:29\u0026ndash;33\u003c/li\u003e\n\u003cli\u003eMantzavinou A, Uppara M, Chan J, Patel B (2022) Robotic versus open pancreaticoduodenectomy, comparing therapeutic indexes; a systematic review. Int J Surg 101:106633\u003c/li\u003e\n\u003cli\u003evan Oosten AF, Ding D, Habib JR, Irfan A, Schmocker RK, Sereni E, Kinny-Koster B, Wright M, Groot VP, Molenaar IQ, Cameron JL, Makary M, Burkhart RA, Burns WR, Wolfgang CL, He J (2021) Perioperative Outcomes of Robotic Pancreaticoduodenectomy: a Propensity-Matched Analysis to Open and Laparoscopic Pancreaticoduodenectomy. J Gastrointest Surg 25:1795\u0026ndash;1804\u003c/li\u003e\n\u003cli\u003eShyr BU, Chen SC, Shyr YM, Wang SE (2020) Surgical, survival, and oncological outcomes after vascular resection in robotic and open pancreaticoduodenectomy. Surg Endosc 34:377\u0026ndash;383\u003c/li\u003e\n\u003cli\u003eWang SE, Shyr BU, Chen SC, Shyr YM (2018) Comparison between robotic and open pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: A propensity score-matched study. Surgery 164:1162\u0026ndash;1167\u003c/li\u003e\n\u003cli\u003eClavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santiba\u0026ntilde;es E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187\u0026ndash;196\u003c/li\u003e\n\u003cli\u003eBassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 161:584\u0026ndash;591\u003c/li\u003e\n\u003cli\u003eWente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, B\u0026uuml;chler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761\u0026ndash;768\u003c/li\u003e\n\u003cli\u003eWente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Buchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20\u0026ndash;25\u003c/li\u003e\n\u003cli\u003eBesselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Buchler MW, Busch OR, Charnley RM, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Izbicki JR, Lillemoe KD, Neoptolemos JP, Sarr MG, Shrikhande SV, Sitarz R, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ, International Study Group on Pancreatic S (2017) Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery. Surgery 161:365\u0026ndash;372\u003c/li\u003e\n\u003cli\u003eLangan RC, Huang CC, Mao WR, Harris K, Chapman W, Fehring C, Oza K, Jackson PG, Jha R, Haddad N, Carroll J, Hanna J, Parker A, Al-Refaie WB, Johnson LB (2016) Pancreaticoduodenectomy hospital resource utilization in octogenarians. Am J Surg 211:70\u0026ndash;75\u003c/li\u003e\n\u003cli\u003eMansfield SA, Mahida JB, Dillhoff M, Porter K, Conwell D, Ranalli M, Walker JP, Aldrink JH (2016) Pancreaticoduodenectomy outcomes in the pediatric, adolescent, and young adult population. J Surg Res 204:232\u0026ndash;236\u003c/li\u003e\n\u003cli\u003eYeh CC, Jeng YM, Ho CM, Hu RH, Chang HP, Tien YW (2010) Survival after pancreaticoduodenectomy for ampullary cancer is not affected by age. World J Surg 34:2945\u0026ndash;2952\u003c/li\u003e\n\u003cli\u003eFisher CJ, Egan MK, Smith P, Wicks K, Millis RR, Fentiman IS (1997) Histopathology of breast cancer in relation to age. Br J Cancer 75:593\u0026ndash;596\u003c/li\u003e\n\u003cli\u003eMonson K, Litvak DA, Bold RJ (2003) Surgery in the aged population: surgical oncology. Arch Surg 138:1061\u0026ndash;1067\u003c/li\u003e\n\u003cli\u003eCho SJ, Yoon JH, Hwang SS, Lee HS (2007) Do young hepatocellular carcinoma patients with relatively good liver function have poorer outcomes than elderly patients? J Gastroenterol Hepatol 22:1226\u0026ndash;1231\u003c/li\u003e\n\u003cli\u003eEmile SH, Elfeki H, Shalaby M, Elbalka S, Metwally IH, Abdelkhalek M (2020) Patients with early-onset rectal cancer aged 40 year or less have similar oncologic outcomes to older patients despite presenting in more advanced stage; A retrospective cohort study. Int J Surg 83:161\u0026ndash;168\u003c/li\u003e\n\u003cli\u003eLlanos O, Butte JM, Crovari F, Duarte I, Guzm\u0026aacute;n S (2006) Survival of young patients after gastrectomy for gastric cancer. World J Surg 30:17\u0026ndash;20\u003c/li\u003e\n\u003cli\u003eNakamura R, Saikawa Y, Takahashi T, Takeuchi H, Asanuma H, Yamada Y, Kitagawa Y (2011) Retrospective analysis of prognostic outcome of gastric cancer in young patients. Int J Clin Oncol 16:328\u0026ndash;334\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3410686/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3410686/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePancreaticoduodenectomy procedures were performed early in young individuals, with a few days about the risk and survival after robotic pancreaticoduodenectomy.\u003c/p\u003e\n\u003cp\u003eOur goal was to report the results of robotic pancreaticoduodenectomy in patients older than 50 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur patients were divided into two groups: younger patients (less than 50 years) and older patients (\u0026gt; 50 years). A total of 1110 patients were included in this study:1004 (90.5%) in the elderly group and 106 (9.5%) in the young group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn younger demographics, the prevalence of periampullary cancer is 32.1% as opposed to 76.5%.\u003c/p\u003e\n\u003cp\u003e2. Tumors biological (15.1% versus 3.6%).\u003c/p\u003e\n\u003cp\u003e3. Pseudocapillary and solid malignancies (9.4% and 1.0%, respectively).\u003c/p\u003e\n\u003cp\u003e4. The tissues soft of the pancreas (77.4% vs. 62.5%).\u003c/p\u003e\n\u003cp\u003eThere was a higher prevalence of non-dilated (≤ 3 mm) ducts within the pancreas (77.4% vs. 46.3%) in the younger group.\u003c/p\u003e\n\u003cp\u003e6. Young people group's hospitalization was less (median, 16 vs. 20 days).\u003c/p\u003e\n\u003cp\u003e7- The younger group fared better after treatment for total periampullary cancers of the with a 5-year prognosis of 76.4% compared to 46.7% in the older category.\u003c/p\u003e\n\u003cp\u003e8. The results of the other surgeries didn't vary significantly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRobotic pancreaticoduodenectomy is associated with favorable survival outcomes for periampullary cancer in younger people (\u0026lt;50 years) and equivalent surgical outcomes compared to older individuals (≥50 years). These outcomes show that robotic pancreaticoduodenectomy is safe and effective in a subset of pediatric patients.\u003c/p\u003e\n\u003cp\u003eFollowing pancreaticoduodenectomy, the number of juvenile robotic tumor adenocarcinomas\u003c/p\u003e","manuscriptTitle":"Safety and hazards of middle-life robotic pancreaticoduodenectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-10 20:20:34","doi":"10.21203/rs.3.rs-3410686/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8750ef2d-d335-4b10-9e44-20ccce6c827f","owner":[],"postedDate":"October 10th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-10-26T17:29:13+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-10 20:20:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3410686","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3410686","identity":"rs-3410686","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}