To explore the feasibility, safety, efficacy, and preliminary experience of robotic pancreatoduodenectomy (RPD) in the treatment of pediatric malignant pancreaticobiliary tumors.

A retrospective analysis was performed on the clinical data of 3 children with malignant pancreaticobiliary tumors who underwent RPD at Guangzhou Medical University Affiliated Women and Children's Medical Center from Apr. 2023 to Feb. 2024. The patients were 1 male and 2 female. The surgical procedure was robotic pylorus-preserving pancreatoduodenectomy (RPPPD) using the da Vinci robotic system Xi. Postoperative follow-up was conducted for 12 to 18 months.

The 3 patients were aged 29 months, 12 years, and 23 months, respectively. Case 1 had a tumor located in the ampulla of vater, invading the pancreatic head and common bile duct, with a size of 31 mm×27 mm×25 mm. Case 2 and 3 had tumors located in the pancreatic head, with sizes of 110 mm×98 mm×90 mm and 69 mm×58 mm×45 mm, respectively. All three patients underwent RPPPD. Postoperative pathological examination results revealed ampullary rhabdomyosarcoma in patient 1, solid pseudopapillary neoplasm in patient 2, and pancreatoblastoma in patient 3. All patients were discharged from the hospital with complete recovery. Patient 1 experienced gastric emptying disorder during the perioperative period, which resolved after 1 week of conservative treatment. During the follow-up period, all patients recovered well without any intraoperative or postoperative complications such as major bleeding, pancreatic fistula, biliary fistula, gastrointestinal anastomotic leakage, anastomotic stricture, intestinal obstruction, acute pancreatitis, or tumor recurrence. The three children are growing and developing well.

Robotic pancreatoduodenectomy is safe and feasible for malignant pancreaticobiliary tumors in children, with good short-term and medium-term outcomes.