Xourafas D, et al. - In view of the continous increase in utilization of minimally invasive approaches for pancreatoduodenectomy (PD), researchers search for factors associated with prolonged operative time (OpTime) and hospital length of stay (LOS). In addition, they assessed if these factors are consistent across surgical approaches. Using the ACS-NSQIP targeted pancreatectomy database from 2014 to 2016, they identified 10,970 patients who underwent open (OPD), laparoscopic (LPD), or robotic (RPD) pancreatoduodenectomy. LOS was longer for the open and laparoscopic approaches, whereas OpTime was shortest for OPD. A prolonged OpTime was noted in independent association with ASA class ≥ 3, preoperative XRT, pancreatic duct < 3 mm, T stage ≥ 3, and vascular resection for OPD; T stage ≥ 3 and vascular resection for LPD; and malignancy and conversion to laparotomy for RPD. Increased LOS was predicted independently with age ≥ 65 years, ASA class ≥ 3, hypoalbuminemia, and preoperative blood transfusion for OPD as well as an OpTime > 370 min and specific postoperative complications for all surgical approaches.