Pancreatic cancer is known to be one of the deadliest cancers in Malaysia with every 2 in 100,000 individuals developing it in their lifetime. It may not be as common as colon, breast or lung cancer, but pancreatic cancer carries an unfavourable prognosis as it is usually diagnosed late.

The only chance of cure, as recommended by Professor Dr Yoong Boon Koon, Sunway Medical Centre, Sunway City’s (SMC) Hepatopancreatobiliary (HPB) Consultant Surgeon is pancreatic surgery to remove the cancerous cells when it is detected early or before it turned cancerous. These are usually followed by chemotherapy.

According to Dr Yoong, “If the cancer is located at the tail and body of the pancreas, removal of the pancreatic tail, spleen and surrounding lymphatic tissues is the treatment of choice. However, if the cancer is found at the head of the pancreas, a complex surgery known as the pancreatidoduodenectomy (Whipple’s procedure) is needed, where it removes the pancreatic head, duodenum, bile duct, and gallbladder.”

The complex Whipple’s surgery is traditionally done as an open surgery, taking 5 to 6 hours and requires highly skilled hands. But with the aid of a surgical robot, such as the da Vinci Xi, this arduous surgery can now be performed with a minimally invasive approach through a few keyholes size incisions.

With this advancement in robotics, Dr Yoong has on June 17, 2023, successfully conducted the robotic Whipple procedure with the 4th generation surgical robot, da Vinci Xi in SMC. SMC currently has two units of da Vinci Xi available and the only hospital in Malaysia offering robotic assisted Whipple’s procedure.

The alert signs and treatments

The most common signs of pancreatic cancer are:

  • Jaundice – a medical condition in which the skin and the white parts of the eyes become yellow
  • Intestinal obstruction
  • Loss of appetite and weight
  • Abdominal pain or mass

“Unfortunately, these symptoms often present late and curative treatments are not feasible on diagnosis. However, for those detected at early state during screening (where there is a raised CA19-9 in blood test or pancreatic mass on ultrasound), surgical removal of the tumour is the only chance of cure,” shares Dr Yoong.

He also adds, “Those detected with precancerous tumours carry the best prognosis and surgical resection would usually cure the disease.”

Additionally, pancreatic cancer that is still localised to the pancreas (stage 1-3), surgical resection is followed by chemotherapy, while for cancer that has spread to other organs (stage 4), palliative chemotherapy is the treatment of choice.

Hence, Dr Yoong advises those who experience these signs to seek medical advice as soon as possible.

Robotics offering better surgical option

This minimally invasive surgical option is only suitable for patients in the early stage of cancer or pre-cancerous conditions. “Most patients, except those with poor lung or heart functions, and poor general health, are suitable for robotic Whipple procedure,” says Dr Yoong, adding, “Patients with multiple previous abdominal surgery can make this surgery more challenging.”

Nevertheless, robotic assisted surgery has many benefits such as smaller incisions required compared to traditional surgery, the dextrality of the robotic arms allows it to perform better in deep and narrow spaces that is difficult to access with hands, and with the magnifying view of the robotic controlled camera, anatomy is better visualised making injuries less likely.

With that, patient recovery is much faster and able to be discharged earlier due to the smaller wounds and less physiology disturbance, they suffer less pain, there is also lower risk of infection with lower complications, which allows them to discharge earlier.

Having the use of robots in surgery offers a higher success rate when case selection is done correctly and should there be challenges to proceed, the surgeon has the option of converting it into an open surgery. Indeed, robotic surgery is changing the map of medicine.

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