{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:41:41Z","timestamp":1791261701809,"version":"4.1.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","funder":[{"name":"Liver and Gastrointestinal Disease (LGID) Foundation"},{"name":"FZ-Healthcare Foundation"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To establish international benchmark values for relevant outcome parameters in robotic Whipple.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary Background Data:<\/jats:title>\n                    <jats:p>For safe adoption of surgical innovation, robust quality control is essential. Benchmarking is a validated tool for assessing surgical performance. Recent international consensus identified establishing benchmark values for robotic Whipple as top priority.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed consecutive patients undergoing robotic Whipple between 2020-2023 with a minimum one-year follow-up. Reference centers were required to perform \u226515 cases\/year, be scientifically active in the field, and maintain a prospective database. Benchmark criteria included benign or resectable malignant disease without neoadjuvant therapy, arterial resection, major co-morbidities, or significant previous abdominal surgery. Benchmarks were established for 13 outcome parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result:<\/jats:title>\n                    <jats:p>\n                      The benchmark cohort comprised 418 patients from 12 centers across four continents. Benchmark values were: conversion rate \u22644.3%, transfusion rate \u22642.1%, 6-month mortality \u22642.2%, major complications \u226423.2%, and CCI\u00ae \u226420.9. Clinically relevant pancreatic fistula (grade B\/C) and hemorrhage (grade B\/C) rates were \u226423.6% and \u226412.7%, respectively. For pancreatic ductal adenocarcinoma (n=123), the benchmark for lymph node yield was \u226520. Higher surgical difficulty was associated with increased overall postoperative morbidity (R\n                      <jats:sup>2<\/jats:sup>\n                      =0.38,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.019), higher center caseload with reduced pancreas-specific complications (R\n                      <jats:sup>2<\/jats:sup>\n                      =0.28,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.044). Independent POPF predictors included duct diameter \u22644\u00a0mm (OR 1.37, 95% CI: 1.03, 1.82), anticoagulation (OR 2.45, 95% CI: 1.47, 3.99), and indication other than PDAC (OR 2.33, 95% CI: 1.68, 3.27).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study establishes the first international benchmarks for robotic Whipple, demonstrating oncologic outcomes and morbidity comparable to open surgery with the benefits of minimally invasive surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/sla.0000000000007014","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:00:44Z","timestamp":1768971644000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Setting the Standard in Robotic Whipple Surgery"],"prefix":"10.1097","author":[{"given":"Matthias","family":"Pfister","sequence":"first","affiliation":[{"name":"Hub for Translational Research and Liver\/GI Health, Zurich, Switzerland"},{"name":"Department of Surgery and Transplantation, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, University of Zurich, Zurich, Switzerland"},{"name":"Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fariba","family":"Abbassi","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, University of Zurich, Zurich, Switzerland"},{"name":"Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael L. C.","family":"Araujo","sequence":"additional","affiliation":[{"name":"Division of HPB Surgery, Department of Surgery, Carolina\u2019s Health Care Hospital, Charlotte, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram A.","family":"Chaudhari","sequence":"additional","affiliation":[{"name":"GI and HPB Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rim","family":"Cherif","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Est Cr\u00e9teil, UPEC, Cr\u00e9teil, France, INSERM, U955, Team \u201cVirus H\u00e9patologie Cancer\u201d, Cr\u00e9teil, France"},{"name":"Department of Digestive and Hepatobiliary Surgery, Assistance Publique-H\u00f4pitaux de Paris, Henri Mondor University Hospital, Cr\u00e9teil, France, GRCT Optima"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laleh","family":"Foroutani","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California - San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Giannone","sequence":"additional","affiliation":[{"name":"Division of Hepato-Biliary and Pancreatic Surgery, Nouvel H\u00f4pital Civil, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ginesini","sequence":"additional","affiliation":[{"name":"Division of General and Transplant Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Iben-Khayat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Centre Hospitalier Regional Orleans, Orleans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boram","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Nunez","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chie","family":"Takishita","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W.","family":"Underwood","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Vigia","sequence":"additional","affiliation":[{"name":"Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaina","family":"Vivian","sequence":"additional","affiliation":[{"name":"The Liver Institute, Methodist Dallas Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiga","family":"Wakabayashi","sequence":"additional","affiliation":[{"name":"Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Alseidi","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California - San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Di Benedetto","sequence":"additional","affiliation":[{"name":"HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Boggi","sequence":"additional","affiliation":[{"name":"Division of General and Transplant Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Brustia","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Est Cr\u00e9teil, UPEC, Cr\u00e9teil, France, INSERM, U955, Team \u201cVirus H\u00e9patologie Cancer\u201d, Cr\u00e9teil, France"},{"name":"Department of Digestive and Hepatobiliary Surgery, Assistance Publique-H\u00f4pitaux de Paris, Henri Mondor University Hospital, Cr\u00e9teil, France, GRCT Optima"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan-To","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Dillhoff","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian K. P.","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho-Seong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetto","family":"Ielpo","sequence":"additional","affiliation":[{"name":"Hepato-Biliary and Pancreatic Surgery Unit, Hospital del Mar, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel A.","family":"Machado","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Martinie","sequence":"additional","affiliation":[{"name":"Division of HPB Surgery, Department of Surgery, Carolina\u2019s Health Care Hospital, Charlotte, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo Pinto","family":"Marques","sequence":"additional","affiliation":[{"name":"Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Mejia","sequence":"additional","affiliation":[{"name":"The Liver Institute, Methodist Dallas Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Nagakawa","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Pessaux","sequence":"additional","affiliation":[{"name":"Division of Hepato-Biliary and Pancreatic Surgery, Nouvel H\u00f4pital Civil, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio M.","family":"Polanco","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Saint-Marc","sequence":"additional","affiliation":[{"name":"Department of Surgery, Centre Hospitalier Regional Orleans, Orleans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailesh V.","family":"Shrikhande","sequence":"additional","affiliation":[{"name":"GI and HPB Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go","family":"Wakabayashi","sequence":"additional","affiliation":[{"name":"Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9916-7905","authenticated-orcid":false,"given":"Pierre-Alain","family":"Clavien","sequence":"additional","affiliation":[{"name":"Hub for Translational Research and Liver\/GI Health, Zurich, Switzerland"},{"name":"Department of Surgery and Transplantation, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,21]]},"container-title":["Annals of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/SLA.0000000000007014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:00:45Z","timestamp":1768971645000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/SLA.0000000000007014"}},"subtitle":["International Multicenter Benchmark Analysis"],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1097\/sla.0000000000007014","relation":{},"ISSN":["0003-4932","1528-1140"],"issn-type":[{"value":"0003-4932","type":"print"},{"value":"1528-1140","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]},"assertion":[{"value":"2025-09-25","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}