Failure to rescue after pancreatoduodenectomy and the advent of robotic surgery: outcomes across 20 years practice.

BACKGROUND

Pancreatoduodenectomy (PD) remains associated with substantial morbidity, but mortality has dropped in specialized centers. Failure to rescue (FTR), defined as mortality following major postoperative complications, has emerged as a key indicator of surgical quality. The influence of surgical approach on FTR remains uncertain.

METHODS

A retrospective review of elective open and robotic PDs performed between 2007 and 2024 at a single high-volume center was conducted. Demographics, comorbidities, operative details, and major complications were analyzed. Rescue interventions included reoperation, interventional radiology, or intensive care unit (ICU) escalation. The primary outcome was ninety-day FTR.

RESULTS

Among 572 open and 140 robotic PDs, median age was 68 years and 50.1% were female. Major complications occurred in 28%. Thirty- and ninety-day mortality were 1.5% and 3%, respectively; FTR was 8.4% (n = 17/202). Compared with open PD, robotic procedures showed fewer major complications (21% vs 30%, p = 0.042) and shorter median hospital stay (7 vs 9 days, p < 0.001). FTR was not influenced by surgical approach, but was associated with higher comorbidity, organ failure and lack of timely ICU escalation.

CONCLUSION

Over nearly two decades, low FTR rates were achieved. Rescue success reflected patient risk, complication severity, and institutional response.