BMC Surg. 2026 Jul 6. doi: 10.1186/s12893-026-03942-9. Online ahead of print.
ABSTRACT
BACKGROUND: Neoadjuvant therapy (NAT) has become the recommended treatment approach for patients with borderline resectable or locally advanced pancreatic cancer. However, pancreatic peritumoral fibrosis and proximity of the tumor to major vessels make surgery after NAT challenging. The feasibility and safety of robotic approaches remain unclear.
METHODS: A retrospective analysis was conducted on consecutive pancreatic cancer patients who underwent either open pancreatic surgeries (OPS) or robotic pancreatic surgeries (RPS) following NAT between February 2017 and April 2025. Outcomes, including R0 resection rates, postoperative complication rates, disease-free survival (DFS), and overall survival (OS), were compared between the two groups.
RESULTS: The rate of combined vascular resection and reconstruction was significantly higher in OPS group compared to RPS group following NAT. A total of 43 patients underwent surgical resection which did not require venous segmental resection and reconstruction, including 23 RPS and 20 OPS, were finally included in the analysis. The two groups were well balanced in baseline characteristics, except for BMI. In the RPS group, one case (4.3%) was converted into laparotomy. The RPS group was associated with longer operative time (340.0 min vs. 254.0 min, p = 0.015). The number of harvested lymph nodes was significantly higher in the RPS group compared to the OPS group(25 vs. 18, p = 0.049). There were no significant differences in R0 resection rates between the groups. The overall complication rate was significantly lower in the RPS group (21.7% vs. 55.0%, p = 0.024), while the rates of severe complications, clinically relevant pancreatic fistula, and postoperative hemorrhage did not differ between groups. Postoperative hospital stay was slightly shorter in the RPS group, though not statistically significant. There were no significant differences in DFS or OS.
CONCLUSION: In carefully selected patients with pancreatic cancer following neoadjuvant therapy who did not require vascular segmental resection and reconstruction, a robotic approach appeared technically feasible and was associated with favorable short-term postoperative outcomes and a greater lymph node yield. These findings should be considered exploratory, and further prospective studies are warranted to better define the role of robotic surgery in this setting.
PMID:42410418 | DOI:10.1186/s12893-026-03942-9
