title: Outcomes of robotic surgery for pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  To explore the effectiveness, safety, and efficacy of the robot-assisted surgery in the radical resection of pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  The clinical data of 72 patients with PDAC who underwent radical resection using the da Vinci Surgical System from April 2010 to December 2014 were retrospectively analyzed.
  
  
  RESULTS
  Among these 72 patients, three were converted to conventional laparotomy due to the vascular invasion or due to the difficulties in tissue isolation from the surrounding organs. Among 39 patients who underwent the pancreatoduodenectomy, the average operative time was 395.3±118.8 min, and the mean intra-operative blood loss was 447.3±269.9 mL. Among 31 patients who underwent the distal pancreatectomy (DP), the average operative time was 185.5±74.1 min, and the mean intra-operative blood loss was 267.1±305.3 mL. In two patients who received the middle pancreatectomy (MP), the average operative time was 225 min and mean intra-operative blood loss was 100 mL. Among all the 72 patients, an average of 4.2±2.6 lymph nodes were dissected, with an average hospital stay of 22.6±10.7 days. Complications were observed in 18 patients, which included pancreatic fistula (n=11), bile leak (n=5), anastomotic bleeding (n=2), pancreatic fistula complicated with portal vein thrombosis (n=1), and anastomotic bleeding complicated with acute renal failure (n=1). Except that one patient died due to post-operative bleeding and acute renal failure, all the other patients were cured after conservative treatment. These 72 patients were followed for 1-45 (15.6±5.8) months, during which 10 patients died. Eleven patients suffered from recurrence or metastasis, among which 6 had local recurrence, 4 had liver metastasis, and 1 had ascites accompnaied with incision site tumor metastasis.
  
  
  CONCLUSIONS
  Radical resection of PDAC by robotic surgical system is safe and feasible. It has less surgical trauma and enables faster post-operative recovery, and therefore can achieve the lymph node dissection scope and tumor resection margin required by the standards of radical resection for pancreatic cancer. Nevertheless, its long-term efficacy requires further validation.
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhan
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Xiaxing
authors.initials: X
authors.lastname: Deng
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Yuanchi
authors.initials: Y
authors.lastname: Weng
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Jiabin
authors.initials: J
authors.lastname: Jin
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Zhichong
authors.initials: Z
authors.lastname: Wu
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Li
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Baiyong
authors.initials: B
authors.lastname: Shen
authors.affiliation: 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China.
authors.forename: Chenghong
authors.initials: C
authors.lastname: Peng
keywords: Robot-assisted surgery; pancreatic ductal adenocarcinoma (PDAC); radical resection