Pancreatic cancer and periampullary malignancies are widely regarded as among the most challenging diseases in surgical oncology, given the extensive operative field and high procedural risk involved. Over the past decades, Taipei Veterans General Hospital (TVGH) has systematically advanced pancreatic surgery and has now performed a total of 2,140 pancreaticoduodenectomies. Of these, 719 cases were completed using robotic-assisted minimally invasive pancreaticoduodenectomy (Robotic Pancreaticoduodenectomy, RPD). This volume represents the largest accumulated experience with RPD in Taiwan, positioning TVGH as a national reference center and a benchmark model for pancreatic cancer treatment.

Volume Translates Into Quality

The large procedural volume at TVGH has translated directly into measurable improvements in patient outcomes and postoperative quality of life. Experience gained from hundreds of robotic procedures has allowed the surgical team to refine techniques, standardize workflows, and optimize perioperative management, producing outcomes that differ markedly from those of traditional open surgery.

In robotic pancreaticoduodenectomy, the average intraoperative blood loss at TVGH is approximately 200 c.c., and in selected cases can be nearly negligible. By comparison, patients undergoing open pancreaticoduodenectomy (Open Pancreaticoduodenectomy, OPD) experience an average blood loss of around 500 c.c. Hospitalization time also differs substantially. Patients receiving RPD stay an average of 17 days, whereas those undergoing OPD are typically discharged after about 26 days. Clinically notable cases include an 84-year-old patient who was able to return home just six days after surgery.

Expanding Indications to Elderly and High-Risk Patients

The accumulated expertise at TVGH has made it possible to extend minimally invasive pancreaticoduodenectomy to patient populations traditionally considered high risk. Successful RPD procedures have been performed in patients as old as 95 years, as well as in individuals receiving long-term dialysis. These outcomes underscore the role of minimally invasive surgery in broadening treatment options for vulnerable populations.

Patient-reported outcomes further reflect these benefits. According to institutional satisfaction surveys, 99.05 percent of patients who underwent RPD at TVGH indicated that they would recommend the procedure to others, highlighting both clinical effectiveness and perceived quality of care.

Superior Surgical Outcomes and Survival

From an oncologic perspective, the completion rate for RPD at TVGH reaches 98.7 percent. The operative mortality rate for patients undergoing RPD is 1.3 percent, substantially lower than the 5.1 percent observed with OPD. Long-term outcomes are equally notable: the five-year survival rate following RPD reaches 36.9 percent, a figure that stands in stark contrast to national statistics reported by Taiwan’s National Health Research Institutes, which place overall pancreatic cancer survival at only 3–5 percent.

Postoperative morbidity also favors the minimally invasive approach. The overall complication rate for RPD is 41.3 percent, compared with 63.1 percent for OPD, underscoring the role of robotic surgery in reducing postoperative risk and facilitating recovery.

RPD Versus OPD: A Comparative Overview

When comparing robotic-assisted and open pancreaticoduodenectomy at TVGH, several key differences emerge. RPD is associated with significantly lower blood loss, shorter hospital stays, fewer postoperative complications, and a markedly lower operative mortality rate. These advantages collectively position RPD as a safer and more patient-centered alternative to conventional open surgery in appropriately selected cases.

Redefining Options for a High-Risk Disease

Pancreatic and periampullary cancers remain among the most technically demanding and high-risk malignancies to treat. The extensive experience accumulated by TVGH in pancreaticoduodenectomy—particularly in robotic-assisted minimally invasive surgery—has provided patients with a viable alternative to traditional open procedures. By reducing blood loss, shortening hospitalization, and lowering complication rates, this approach enables even elderly and high-risk patients to benefit from improved postoperative recovery and quality of life.

Through sustained investment in surgical volume, technical refinement, and outcome-driven practice, TVGH has established itself as the national leader in pancreatic cancer surgery and has set a new benchmark for minimally invasive pancreaticoduodenectomy in Taiwan.