A Three-Day Postoperative Recovery Pathway After Robotic Pancreatoduodenectomy

Background and Objective: Enhanced Recovery After Surgery (ERAS) protocols and minimally invasive techniques may accelerate recovery following pancreatoduodenectomy (PD). We evaluated the feasibility and safety of combining minimally invasive PD with a tailored ERAS protocol on post-PD outcomes and quality of life (QoL). Methods: Patients undergoing PD from 2023 to 2025 were identified. The 2019 ERAS Society recommendations for PD were implemented. Multivariable regression was used for adjusted analyses, with performance assessed by area under the curve (AUC) and Brier scores. QoL was measured using the European Organisation for Research and Treatment of Cancer QLQ-C30 and PAN-26 modules. Results: Of 113 patients, 67.3% underwent robotic and 32.7% open PD with comparable baseline characteristics. Postoperative day (POD) 3 discharge occurred in 34.2% of robotic cases and none of the open cases ( P < 0.001). POD 3 discharge correlated with fewer cumulative 90-day hospital days (3 days vs 5 days, P < 0.001) and overall complications (42.3% vs 68.0%, P = 0.031), without differences in major complications, readmissions, or 90-day mortality. POD 1 drain fluid amylase (DFA) was lower in POD 3 discharges (40 U/L vs 808 U/L, P = 0.014), and DFA <300 U/L identified patients likely to achieve POD 3 discharge without adverse events with good discrimination and calibration (AUC = 0.843; Brier = 0.120). Early discharge was associated with improved overall QoL (+5.6 vs −15.0; P = 0.006) without differences in pain scores (+8.3 vs +12.5; P = 0.240). Conclusions: ERAS protocols with minimally invasive PD facilitated safe POD 3 discharge. POD 1 DFA <300 U/L may help identify patients safe for early discharge without compromising outcomes or QoL.