Robotic pancreaticoduodenectomy with venous resection and reconstruction: a systematic review of perioperative, vascular, oncological and survival outcomes.

چکیده اصلی

Robotic pancreaticoduodenectomy with venous resection and reconstruction (RPD-VR) is one of the most technically challenging procedures in hepatopancreaticobiliary surgery. While acceptance of robotic pancreaticoduodenectomy is growing, the safety, feasibility, and oncologic adequacy of combined portal vein (PV) and/or superior mesenteric vein (SMV) resection remain incompletely defined. A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, Scopus and the Cochrane Library were searched from inception of the databases to June 2026. The Newcastle-Ottawa Scale was used to evaluate methodological quality. Twelve retrospective studies involving 202 patients undergoing RPD-VR were included. Indications were predominantly pancreatic ductal adenocarcinoma, but other periampullary and pancreatic malignancies were included. The venous reconstruction techniques were primary venorrhaphy, patch venoplasty, end-to-end anastomosis and interposition graft reconstruction. The conversion rates ranged from 0% to 36.4%. Major postoperative complications (Clavien-Dindo ≥ III) were 0% to 40%, postoperative pancreatic fistula 0% to 20% and mortality 0% to 14.3%. R0 resection rates ranged from 69.2 to 100% and lymph node harvest from 14.3 ± 6.7 to 60.0 ± 13.9 nodes. Limited long-term data suggested vascular patency rates exceeding 90% in the studies reporting follow-up imaging. Overall survival, disease-free survival and recurrence outcomes were, however, reported to a limited extent and heterogeneously across studies. Existing data suggest RPD-VR is technically feasible and may be associated with acceptable perioperative, vascular, and oncologic outcomes in carefully selected patients treated at experienced centers. However, the currently available evidence is limited by the retrospective study designs, small sample sizes, and lack of long-term oncologic follow-up. Standardised reporting and solid long-term outcome assessment in prospective multicenter studies are needed to better define the role of RPD-VR in contemporary pancreatic surgery. Prospero ID: CRD420261417822.

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