Clinical efficacy of robotic pancreaticoduodenectomy in treatment of periampullary carcinoma

Objective To investigate the clinical application and efficacy of Da Vinci robotic assisted pancreaticoduodenectomy (RPD) in treatment of periampullary carcinoma（PAC）. Methods The clinical data of 8 patients with PAC (5 cases of pancreatic head adenocarcinoma, 2 cases of duodenal adenocarcinoma, and 1 case of adenocarcinoma of the lower bile duct) admitted to Yancheng First Peoples Hospital from December 2021 to June 2023 were retrospectively analyzed. There were 4 males and 4 females, aged (63±10) years，and all of them were treated with RPD. The patients status during and after operation, and at follow-up were observed, with the follow-up time until June 2023. Results Eight patients successfully completed RPD, without any conversion to open surgery. The surgery time was (358±68) min, and the intraoperative blood loss was (240±112) mL. Only one patients received intraoperative allogeneic blood transfusion. All patients had negative pathological margins and achieved R0 resection. The time to gastric tube extraction, time to initial diet intake, time for getting out of bed and postoperative hospital stay of 8 patients were (3.6±1.1), (2.8±0.6), (2.6±0.4) and (20.8±4.2) days, respectively. There was no secondary operation and no perioperative death. Six cases had perioperative complications (some cases complicated with multiple complications), including 4 cases of mild pancreatic leakage, 1 case of biliary leakage, 3 cases of pleural or abdominal effusion,1 case of intestinal retention,and 1 case of gastric obstruction, all of which were cured after symptomatic conservative treatment. All 8 cases received a median follow-up of 10 months, with 2 cases experiencing tumor recurrence and metastasis, and 6 cases without recurrence and metastasis . One case died due to pulmonary embolism,and 7 cases entered the adjuvant chemotherapy procedure after surgery and all survived, with good living conditions. Conclusion RPD is safe and feasible for the treatment of PAC,and can be applied individually and reasonably.However, long-term prognosis evaluation requires large-size, high-quality clinical studies."