Robotic Distal Pancreatectomy Has a Lower Incidence Than Open Surgery of Clinically Relevant Pancreatic Fistula: a Propensity Score–matched Analysis with Emphasis on Inflammation and Microbial Contamination

Robotic distal pancreatectomy (RDP) is being adopted increasingly, but its impact on clinically relevant postoperative pancreatic fistula (CR-POPF) compared with that of open distal pancreatectomy (ODP) remains unclear. We compared the incidences of CR-POPF after RDP vs. ODP, focusing on postoperative inflammation and drain bacterial contamination. The subjects of this retrospective analysis were 125 patients who underwent stapler-based distal pancreatectomy at a single center between 2013 and 2025 (RDP, n = 50; ODP, n = 75). Propensity score matching yielded 32 matched patients in each group. Outcomes included CR-POPF, postoperative C-reactive protein, drain amylase levels, and drain fluid cultures on postoperative days (PODs) 1 and 3. Multivariable analysis was performed to identify the factors associated with CR-POPF. After matching, it was evident that the RDP group had less blood loss (median 95 vs. 573 mL, p < 0.001) and fewer transfusions (3