Robotic pancreaticoduodenectomy for pancreatic cancer: a narrative review

Background and Objective: The indications and evidence base for robotic-assisted pancreaticoduodenectomy have grown exponentially over the last two decades and robotic-assisted resection is now considered a safe and oncologically-equivalent surgical option for patients with pancreaticobiliary cancers. In this narrative review, we outline the published literature regarding technical considerations and operative steps for robotic pancreaticoduodenectomy including techniques for safe vascular resection and reconstruction. Methods: A PubMed search was performed to identify all articles, in English, published between January 1^st, 1996 to July 18^th, 2022 which were related to robotic-assisted pancreaticoduodenectomy for patients with pancreatic cancer. Key Content and Findings: Significant advances in have been made in robotic-assisted techniques and approaches for patients requiring pancreaticoduodenectomy and these are described in detail. Advances have additionally been made regarding intraoperative visualization and identification of vascular and biliary structures. More research is needed to characterize oncologic outcomes for patients undergoing open versus robotic pancreaticoduodenectomy, including the frequency of adjuvant chemotherapy completion as well as differences in progression-free and overall survival. Conclusions: The surgical technique of robotic-assisted pancreaticoduodenectomy has evolved and improved as greater number of surgeons gain experience with this technique. Advanced procedures such as vascular resection and reconstruction and the TRIANGLE resection are possible for surgeons with previous experience in robotic-assisted pancreatic surgery. The results of a recently completed randomized clinical trial for patients with pancreatic cancer undergoing robotic-assisted versus open pancreaticoduodenectomy are awaited.