Pancreaticoduodenectomy is the standard surgical procedure for treating malignant tumors in the head and neck of the pancreas, the uncinate process, the ampulla of Vater, and the lower segment of the bile duct. The operation involves multi-organ resection and complex gastrointestinal reconstruction. Pancreatic fistula is a common complication after pancreaticoduodenectomy, often leading to infections, bleeding, and other complications, which can result in perioperative mortality. In recent years, with advancements in surgical techniques and concepts, as well as close collaboration among multidisciplinary teams, the management of pancreatic fistulas following pancreaticoduodenectomy has become increasingly optimized. Key aspects such as early identification, adequate drainage, nutritional support, inhibition of exocrine pancreatic secretion, infection control, and timely reoperation are all crucial in managing postoperative pancreatic fistulas. However, the current strategies for managing pancreatic fistulas, while clinically applied, are essentially symptomatic supportive treatments. There is currently no definitive treatment that can heal pancreatic fistulas within a short period. Therefore, there is an urgent need for significant progress in basic research and the translation of new materials to provide new strategies for managing pancreatic fistulas after pancreaticoduodenectomy.

Pancreaticoduodenectomy is the standard surgical procedure for treating malignant tumors in the head and neck of the pancreas, the uncinate process, the ampulla of Vater, and the lower segment of the bile duct. The operation involves multi-organ resection and complex gastrointestinal reconstruction. Pancreatic fistula is a common complication after pancreaticoduodenectomy, often leading to infections, bleeding, and other complications, which can result in perioperative mortality. In recent years, with advancements in surgical techniques and concepts, as well as close collaboration among multidisciplinary teams, the management of pancreatic fistulas following pancreaticoduodenectomy has become increasingly optimized. Key aspects such as early identification, adequate drainage, nutritional support, inhibition of exocrine pancreatic secretion, infection control, and timely reoperation are all crucial in managing postoperative pancreatic fistulas. However, the current strategies for managing pancreatic fistulas, while clinically applied, are essentially symptomatic supportive treatments. There is currently no definitive treatment that can heal pancreatic fistulas within a short period. Therefore, there is an urgent need for significant progress in basic research and the translation of new materials to provide new strategies for managing pancreatic fistulas after pancreaticoduodenectomy.

Pancreatic surgery is characterized by great trauma, difficult operation, high risk and high complication rate. Minimally invasive, refined and standardized pancreatic surgery is the future trend. With its advantages of high precision, high safety, and more realistic and clear operating field, robotic pancreatic surgery has gradually become the preferred method of pancreatic surgery worldwide. In the past 10 years, more than a dozen large pancreas centers in China have matured to carry out robotic pancreatic surgery, including pancreaticoduodenectomy, pancreaticocaudectomy, pancreatic tumor enucleation, middle pancreatectomy, total pancreatectomy, pancreaticodectomy with duodenum preserved and other pancreatic surgery methods. However, there are still some problems in robotic pancreatic surgery, such as complex system construction, lack of force feedback, inadequate imaging fusion, and immature remote operation. Pancreatic surgeons should continue to carry out high-quality clinical studies on robotic pancreatic surgery to verify its safety and effectiveness, and standardize robotic pancreatic surgery with the accumulation of experience.

To investigate the differences in postoperative short-term complications and long-term prognosis of pancreatic cancer(PC) patients after total pancreatectomy(TP) and pancreaticoduodenectomy(PD).