Robotic pancreatoduodenectomy (rpd) can reduce pancreatic fistula risk but may increase post-pancreatectomy hemorrhage (pph) risk.

• Among 1,925 patients, rpd led to 4.8% ppf vs. 9.3% in open procedures (opd).
• rpd had an increased pph risk (odds ratio 1.63) compared to opd.
• Patients with a pancreatic fistula faced a 3.97 times higher chance of pph, particularly under rpd.

Surgeons should weigh pph risks more heavily in rpd and monitor patients closely for complications.