A systematic review assessing the significance of Body Mass Index as a contributing factor of outcomes in patients undergoing complex robotic pancreatic resections.

Introduction: Pancreatic operations can be regarded as the most complex and high-risk procedures, with robotic approaches offering improved outcomes. This systematic review aimed to evaluate the impact of Body Mass Index (BMI) on perioperative outcomes in robotic pancreaticoduodenectomy (RPD) and robotic distal pancreatectomy (RDP).

Evidence acquisition: Articles published from 2000 to 2024 were sourced from PubMed and Google Scholar using relevant keywords, with inclusion criteria focusing on robotic procedures involving at least 30 patients and BMI classification. Studies using non-robotic approaches were excluded unless used for comparison. Of 17,187 articles identified, 11 met the inclusion criteria. The risk of bias was minimized through dual independent reviewers, adhering to the PRISMA checklist.

Evidence synthesis: Overall, 4645 patients (1501 RPD and 3144 RDP cases) were analyzed and highlighted some BMI-associated challenges, including longer operative times and increased postoperative complications in obese patients. However, robotic techniques were found to mitigate some of these issues, demonstrating reduced blood loss, lower conversion rates, and faster recovery compared to open or laparoscopic methods.

Conclusions: Results showed that robotic approaches improved surgical safety and efficacy, even in patients with BMI >25 kg/m², supporting their use in high-risk populations. Despite limited available studies, findings highlight the need for further research on BMI's influence in robotic pancreatic operations to optimize patient outcomes and refine clinical practices.