Outcomes After Robot-Assisted Versus Open Pancreatoduodenectomy: A Propensity Score-Matching Analysis in a High-Volume Center (TAKUMI-7)

<b>Background/Objectives</b>: Although the safety and feasibility of robot-assisted pancreatoduodenectomy (RPD) compared to open pancreatoduodenectomy (OPD) have been reported, studies investigating the advantages of RPD remain limited. Moreover, only a few studies have investigated the effects of robotic surgery on textbook outcomes (TO). <b>Methods</b>: This single-center retrospective study included 400 patients who underwent RPD and OPD at our institution between January 2017 and December 2025. Outcomes were compared between the RPD (<i>n</i> = 162) and OPD (<i>n</i> = 238) groups using propensity score-matching (PSM) analysis. The factors associated with TO were examined. <b>Results</b>: Before PSM, significant differences were observed between the groups. PSM yielded RPD (<i>n</i> = 117) and OPD (<i>n</i> = 117) with equal preoperative factors. The RPD group demonstrated a significantly shorter operative time (402 vs. 444 min, <i>p</i> < 0.001), lesser blood loss (75 vs. 270 mL, <i>p</i> < 0.001), shorter postoperative hospital stays (13 vs. 22 days, <i>p</i> < 0.001), and fewer major complications (17.1 vs. 44.4%, <i>p</i> < 0.001), resulting in a higher TO achievement rate (76.9 vs. 52.1%, <i>p</i> = 0.001). Adjusted multivariate analyses identified robotic surgery (odds ratio 3.04, <i>p</i> < 0.001) as an independent predictor of TO. <b>Conclusions</b>: This study demonstrated that RPD was potentially superior to OPD in terms of short-term outcomes. Robotic surgery was significantly associated with TO after pancreatoduodenectomy at the expert's hand.