Peng-Yu Ku

Background: Pancreaticoduodenectomy (PD) with portal–superior mesenteric vein (PV-SMV) resection is increasingly performed in borderline-resectable periampullary cancer. While conventional PD is the reference standard, robotic PD (RPD) may improve operative ergonomics and recovery; its performance and learning curve in PV-SMV resection remain unclear. Materials and Methods: We retrospectively reviewed consecutive patients undergoing PD with PV-SMV resection at a single tertiary center by a single surgeon (July 2016–September 2022). Twenty-seven patients met the inclusion criteria and were grouped as conventional PD (n = 14) or RPD (n = 13). To assess the learning curve, RPD cases were stratified as early (cases 1–3) versus late (cases 4–13). Primary outcomes were operative time and blood loss; secondary outcomes included 90-day morbidity/mortality, R0 margin, lymph node yield, length of stay, readmission, and overall survival. Results: Baseline characteristics were comparable between conventional PD and RPD. Median operative time was longer with RPD vs. conventional PD (624.0 [IQR 579.0–794.0] vs. 529.5 [456.5–636.5] mins; p = 0.024). Median blood loss trended lower with RPD (350.0 [200.0–1950.0] vs. 1455.0 [630.0–2940.0] mL; p = 0.254). Rates of clinically relevant complications (including POPF, DGE, and hemorrhage), R0 resection (69% vs. 64%), lymph node retrieval, length of stay, 90-day readmission, 90-day mortality, and overall survival were similar between conventional PD and RPD. Within RPD, operative time and blood loss improved from the early to late phases (794.0 → 601.5 min; 1950.0 → 275.0 mL), consistent with a learning-curve effect, though not statistically significant in this small cohort. Conclusions: In selected patients, RPD with PV-SMV resection is feasible and achieves oncologic and short-term clinical outcomes comparable to conventional PD, with evidence of efficiency gains as experience accrues. These findings support structured training and case accumulation for the safe adoption of complex robotic pancreatic surgery.

Background and Objectives: The pancreatic solid pseudopapillary neoplasm (SPN), a rare tumor predominantly affecting young women, has seen an increased incidence due to improved imaging and epidemiological knowledge. This study aimed to understand the outcomes of different interventions, possible complications, and associated risk factors. Materials and Methods: This study retrospectively analyzed 24 patients who underwent pancreatic surgery for SPNs between September 1998 and July 2020. Results: Surgical intervention, typically required for symptomatic cases or pathological confirmation, yielded favorable outcomes with a 5-year survival rate of up to 97%. Despite challenges in standardizing preoperative evaluation and follow-up protocols, aggressive complete resection showed promising long-term survival and good oncological outcomes. Notably, no significant differences were found between conventional and minimally invasive (MI) surgery in perioperative outcomes. Histopathological correlations were lacking in prognosis and locations. Among the patients, one developed diffuse liver metastases 41 months postoperatively but responded well to chemotherapy and transcatheter arterial chemoembolization, with disease stability observed at 159 postoperative months. Another patient developed nonalcoholic steatohepatitis after surgery and underwent liver transplantation, succumbing to poor medication adherence 115 months after surgery. Conclusions: These findings underscore the importance of surgical intervention in managing SPNs and suggest the MI approach as a viable option with comparable outcomes to conventional surgery.