Robot-Assisted versus Open Pancreatoduodenectomy: Identifying Perioperative Anesthetic Factors associated with Postoperative Morbidity. A retrospective cohort study.

Abstract BackgroundRobot-assisted pancreatoduodenectomy (RAPD) poses several challenges concerning perioperative anesthetic guidance compared to open pancreatoduodenectomy (OPD), e.g. combined pneumoperiotoneum with reversed-Trendelenburg positioning. The primary objective of this observational study is to specify these anesthetic differences of RAPD versus OPD and secondly to identify independent anesthetic factors associated with patient morbidity following RAPD.MethodsAll consecutive patients who underwent either RAPD or OPD between 2017 and 2018 were included for analysis. Patient records were screened for intraoperative vasopressor and fluid administration as well as for results of perioperative arterial blood gas analysis. Variables were compared for the groups RAPD versus OPD, major morbidity following RAPD versus non-major morbidity following RAPD (resp. Clavien-Dindo score ≥ III vs. < III) and high versus low intraoperative blood loss during RAPD. Perioperative factors associated with major postoperative morbidity (Clavien-Dindo ≥ III ) were identified using a logistic regression model.ResultsN=64 RAPD and n=62 OPD patients were included for retrospective analysis. RAPD was associated with higher administration of intraoperative norepinephrine (9.5% of operative time vs. 0% in OPD, p=0.005) and a higher net intraoperative fluid balance (2497.6 vs. 1572.3 ml, p<0.001). During OPD, patients received more frequent and higher doses of colloid fluids compared to RAPD (79.0% vs. 51.6%, p<0.001, median 1000.0 vs. 500.0 ml, p<0.001). Colloid administration during surgery and hyperlactatemia 12 hours postoperatively were associated with major morbidity after RAPD (OR 5.06, 95% CI 1.49-17.20, p=0.009 and OR 3.18, 95% CI 1.01-9.91, p=0.047, respectively).ConclusionsRAPD is a challenging procedure for the anesthesiologist, e.g. considering a higher demand for vasopressors. Inotropic/vasopressor administration as well as the intraoperative fluid balance are associated with (major) morbidity following RAPD. However, it remains unclear whether and in which direction a causal relationship exists.Trial registration: Not applicable.