机器人胰十二指肠切除术在世界范围内越来越多地实施，各个专家中心报告了良好的结果。然而，由于缺乏大型国际研究，尚不清楚在学习曲线期间结果将持续改善到什么程度。国际回顾性多中心病例系列，包括来自欧洲、亚洲和亚洲 8 个国家 18 个中心的机器人胰十二指肠切除术后的连续患者。南美地区的测试截止日期为 2019 年 12 月 31 日。进行累积和分析以确定可行性（手术时间和失血量）和熟练程度（术后胰瘘 B/C 级和主要发病率）学习曲线的拐点。根据学习曲线拐点比较 3 组的结果。总共纳入了 2,186 名接受机器人胰十二指肠切除术的患者。可行性学习曲线是在 30-45 次机器人胰十二指肠切除术后达到的，熟练度学习曲线是在 90 次机器人胰十二指肠切除术后达到的。这些拐点创建了 3 个阶段，与主要发病率相关（24.7%、23.4% 和 12.3%，P < .001），但与 30 天死亡率无关（2.1%、2.0% 和 1.5%，P = .670） ）。其他结果大多持续改善，包括中位手术时间 432、390 和 300 分钟 (P < .0001)，转化率 6.0%、4.7% 和 2.7% (P = .002)，胆漏 7.2%、4.1%、和 2.4% (P < .001)，胰腺切除术后出血 6.5%、6.1% 和 1.8% (n = 21)，但未进行 R0 切除（仅胰腺导管腺癌） 78.5%、73.9% 和 82.8% (P = .35) )，90 天死亡率分别为 3.1%、3.5% 和 2.1% (P = .191)。与每年进行 10-20 例机器人胰十二指肠切除术的中心相比，每年进行超过 20 例机器人胰十二指肠切除术的中心具有较低的转换率、再手术率和较短的中位手术时间。这项国际多中心研究表明，机器人胰十二指肠切除术的大多数结果在 3 个学习曲线期间持续改善阶段对 90 天死亡率没有负面影响。需要在已经超过第一个学习曲线的大容量中心进行随机研究，以将这些结果与开放方法进行比较。版权所有 © 2024。由 Elsevier Inc. 出版。

Robotic pancreatoduodenectomy is increasingly being implemented worldwide, with good results reported from individual expert centers. However, it is unclear to what extent outcomes will continue to improve during the learning curve, as large international studies are lacking.An international retrospective multicenter case series, including consecutive patients after robotic pancreatoduodenectomy from 18 centers in 8 countries in Europe, Asia, and South America until December 31, 2019, was conducted. A cumulative sum analysis was performed to determine the inflection points for the feasibility (operative time and blood loss) and proficiency (postoperative pancreatic fistula grade B/C and major morbidity) learning curves. Outcomes were compared in 3 groups on the basis of the learning curve inflection points.Overall, 2,186 patients after robotic pancreatoduodenectomy were included. The feasibility learning curve was reached after 30-45 robotic pancreatoduodenectomy procedures and the proficiency learning curve after 90 robotic pancreatoduodenectomy procedures. These inflection points created 3 phases, which were associated with major morbidity (24.7%, 23.4%, and 12.3%, P < .001) but not 30-day mortality (2.1%, 2.0%, and 1.5%, P = .670). Other outcomes mostly continued to improve, including median operative time 432, 390, and 300 minutes (P < .0001), conversion 6.0%, 4.7%, and 2.7% (P = .002), bile leakage 7.2%, 4.1%, and 2.4% (P < .001), postpancreatectomy hemorrhage 6.5%, 6.1%, and 1.8% (n = 21) but not R0 resection (pancreatic ductal adenocarcinoma only) 78.5%, 73.9%, and 82.8% (P = .35), and 90-day mortality rate 3.1%, 3.5%, and 2.1% (P = .191). Centers performing >20 robotic pancreatoduodenectomies annually had lower rates of conversion, reoperation, and shorter median operative time as compared with centers performing 10-20 robotic pancreatoduodenectomies annually.This international multicenter study demonstrates that most outcomes of robotic pancreatoduodenectomy continued to improve during 3 learning curve phases without a negative effect on 90-day mortality. Randomized studies are needed in high-volume centers that have surpassed the first learning curves, to compare these outcomes with the open approach.Copyright © 2024. Published by Elsevier Inc.