Objective To investigate the application value of preoperative pancreatic duct stent placement in robotic-assisted complex pancreatic tumor enucleation.
Methods The retros-pective cohort study was conducted. The clinical data of 84 patients who underwent robotic-assisted pancreatic tumor enucleation (REN) for tumors with a distance from the main pancreatic duct ≤2 mm at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2018 to July 2025 were collected. There were 25 males and 59 females, aged (49±16) years. All 84 patients were scheduled for REN, in whom 35 cases with preoperative pancreatic duct stent placement via endos-copic retrograde cholangiopancreatography (ERCP) were set as the stent group, and 49 cases without preoperative pancreatic duct stent placement via ERCP were set as the direct surgery group. Obser-vation indicators: (1) comparison of intraoperative conditions; (2) comparison of postoperative conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann‑Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability.
Results (1) Comparison of intraoperative conditions: all patients in the two groups underwent robotic-assisted pancreatic surgery, without conversion to open laparotomy. Of 35 patients in the stent group, 32 cases underwent REN, 2 cases were converted to robotic-assisted middle pancreatectomy, and 1 case was converted to robotic-assisted duodenum‑preserving pancreatic head resection. Of 49 patients in the direct surgery group, 47 cases underwent REN and 2 cases were converted to robotic-assisted middle pancreatectomy. The operation time and volume of intraoperative blood loss were 110 (90, 170) minutes and 40 (20, 90) mL of the stent group, versus 130 (100, 160) minutes and 40 (10, 90) mL of the direct surgery group, showing no significant difference in the above indicators between the two groups (Z=-1.06, -0.39, P>0.05). (2) Comparison of postoperative conditions: the time to postoperative oral intake and duration of postoperative hospital stay were 5 (4, 7) days and 11 (8, 15) days of the stent group, versus 6 (4, 7) days and 12 (9, 17) days of the direct surgery group, showing no significant difference in the above indicators between the two groups (Z=-0.70, -0.37, P>0.05). Ther number of cases with postoperative acute pancreatitis was 3 versus 3 in the stent group and in the direct surgery group, the number of cases with postoperative biliary fistula was 0 versus 1, the number of cases with postoperative abdominal infection was 2 versus 6, the number of cases with postoperative delayed gastric emptying was 1 versus 1, the number of cases with postoperative bleeding was 4 versus 2, the number of cases with reoperation was 1 versus 1, the number of cases with ≥Clavien‑Dindo grade Ⅲ complications was 4 versus 4, respectively, showing no significant difference in the above indicators between the two groups (P>0.05). Cases with postoperative grade B‑C pancreatic fistula were 5 in the stent group, versus 17 in the direct surgery group, showing a significant difference between the two groups (χ²=4.40, P<0.05).
Conclusion For benign, borderline or low-grade malignant pancreatic tumors (adjacent to the main pancreatic duct ≤2 mm) requiring surgery, pancreatic duct stent placement via ERCP before REN is safe and feasible, and it can reduce the incidence of postoperative grade B-C pancreatic fistula.
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