Intraoperative pancreatic duct defect extent-guided classification (IPDECT): a novel robotic strategy for benign and...

Surgical resection of benign and low-grade malignant pancreatic tumors is challenging due to anatomical complexity and the need to preserve function. Current strategies lack standardization, often resulting in unnecessary healthy tissue resection and impaired functional outcomes. We developed the Intraoperative Pancreatic Duct Defect Extent-Guided Classification (IPDECT), a four-tier system (Types I-IV) based on tumor-main pancreatic duct (MPD) relationships. From August 2021 to August 2025, 122 patients underwent robotic partial pancreatic resections guided by IPDECT, including simple enucleation, enucleation with duct repair and internal stenting, and segmental resection with end-to-end anastomosis. Among 122 patients managed under the IPDECT system, 94 with type I defects showed median operative time of 60.0 min and blood loss of 30.0 ml, with 10.64% experiencing complications including 8.51% POPF. The 11 type II/III cases had mean operative time of 93.50 ± 51.86 min and mean blood loss of 50.00 ± 30.55 ml, with 36.36% complications (all Grade B POPF). The 17 type IV cases required mean operative time of 127.64 ± 50.13 min with median blood loss of 50.0 ml and 5.88% complications. No tumor recurrence, new-onset diabetes, or exocrine insufficiency occurred within the period ranging from 1 month to 4 years. IPDECT standardizes surgical decision-making, reduces complications, and preserves pancreatic function. It offers a reliable framework for managing benign and low-grade malignant pancreatic tumors and warrants further validation through multicenter studies.