Robotic-Assisted Hepatectomy After Pancreaticoduodenectomy: A Three-Case Series

With the expanding use of minimally invasive hepatectomy (MIH), the proportion of patients who undergo MIH after upper abdominal surgery has been increasing. However, there are few reports showing patients who undergo MIH, particularly robot-assisted hepatectomy (RAH), after pancreatoduodenectomy (PD). Herein, we present three cases involving RAH for hepatic metastatic tumors following PD. Case 1 involves a 49-year-old male patient with metachronous liver metastasis after open PD with portal vein resection and right hemicolectomy for advanced-stage pancreatic head cancer - a solitary small liver metastasis located in the superficial part of segment 5 of the liver. RAH was performed after neoadjuvant chemotherapy. The postoperative course was uneventful, and he is currently alive without recurrence one year and six months after hepatectomy. Case 2 involves a 73-year-old female patient with metachronous liver metastasis after open PD for ampullary cancer - a solitary small liver metastasis located in the superficial part of segment 8 of the liver. RAH was performed. Despite the development of postoperative surgical site infection, she is currently alive without recurrence nine months after hepatectomy. Case 3 involves a 65-year-old female patient with metachronous liver and lung metastasis after open PD with portal vein resection for pancreatic head cancer. RAH was performed for the solitary small liver metastasis located in the superficial part of segment 5 of the liver. She was discharged on postoperative day eight, and she underwent video-assisted thoracic surgery for lung metastasis in the right middle lobe after one month. She is currently alive without recurrence six months after hepatectomy. The median surgical duration and blood loss volume were 198 (141-273) minutes and 52 mL, respectively. There were no cases of conversion. None of the patients developed severe postoperative complications, and the patients had favorable short-term outcomes. RAH after PD can be performed safely by utilizing robotic technology in carefully selected patients.