Short-term outcomes of robotic-assisted versus open Frey procedure in chronic pancreatitis: a single-center retrospective cohort study

Early surgery is increasingly recommended for chronic pancreatitis (CP) who meet surgical criteria. The Frey procedure is widely performed, but evidence regarding robotic Frey (R-Frey) remains limited due to the technical challenges posed by pancreatic inflammation and adhesions. This retrospective study included consecutive CP patients who underwent Frey surgery at a single center between January 2016 and May 2025. Primary outcomes were postoperative major complications (PMC; Clavien-Dindo ≥IIIa) and short-term pain relief. A 1:1 propensity score matching (PSM) was performed to reduce baseline imbalance. Among 81 patients included (34 R-Frey, 47 O-Frey), PSM yielded 25 matched pairs. In the overall cohort, no significant differences were observed in PMC (P = 0.270), or the proportion of patients achieving ≥ 50% VAS reduction (P = 0.647). R-Frey was associated with longer operative time (P = 0.013), shorter hospital stay (P = 0.035) and lower ICU stay rate (P = 0.050). After PSM, differences in hospital stay (P = 0.520) and ICU stay (P = 0.185) were no longer significant, while no significant differences were observed in complication rates or pain relief. R-Frey was performed in a selected cohort with more favorable baseline characteristics. After PSM, no significant differences in safety outcomes were detected, although the study was underpowered to establish non-inferiority. The initially observed advantages in hospital stay and ICU stay disappeared after matching, suggesting that they may influenced by patient selection rather than the surgical approach. These findings suggest that R-Frey is partly feasible in carefully selected CP patients, though larger studies are needed to confirm safety equivalence.