Robotic Central Pancreatectomy for Well-Differentiated Neuroendocrine Tumor: Parenchymal-Sparing Procedure

Abstract

Background. The frequency of pancreatic neuroendocrine tumors (pNETs), representative of benign and borderline malignant pancreatic tumors, has been increasing. For pNETs, pancreas-preserving pancreatectomy can be an appropriate option. Conversely, some articles have recently shown that robotic central pancreatectomy (RCP) is feasible and safe. Methods. We demonstrated our standardized technique of RCP. In our technique, pancreaticoenteric reconstruction is performed via a pancreaticogastrostomy to manage the distal pancreatic remnant. We also evaluated our initial experience with four consecutive RCPs for well-differentiated pNETs, retrospectively. Results. In our evaluation, two men and two women had a median age of 45 years (range 36-64). Median tumor size was 2.1 cm (range 1-5), and median operative time was 315 min (range 268-630). No transfusion was given perioperatively. Median hospital stay was 17 days (range 13-22). Grade A postoperative pancreatic fistula was identified in two patients, while grade B was identified in the other two patients. One of the patients was managed using an additional percutaneous drainage. No operative mortality was observed. Pathological findings confirmed R0 resection for all well-differentiated pNETs (pT1: two patients; pT2: two patients). Conclusions. Central pancreatectomy can be carefully selected as a relevant surgical option for well-differentiated pNETs circumscribed in the pancreatic isthmus and body. Our robotic procedure might overcome the complexity of central pancreatectomy, a parenchymal-preserving procedure, with adequate oncological outcomes. ACKNOWLEDGMENT The authors would like to thank Melody Meyer Di Rosa and Lionel Grienenberger for video editing, as well as Catherine Cers for her digital illustrations. DISCLOSURE The authors have no conflicts of interest or financial ties to disclose. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Comparison between robot‐assisted middle pancreatectomy and robot‐assisted distal pancreatectomy for benign or low‐grade malignant tumours located in the neck of the pancreas: A propensity score matched study

“… 21 However, with a robot‐assisted surgical platform, it would not be easy to find a suitable jejunum for fixation. PG was easy to accomplish and did not influence the normal structure of the digestive tract greatly 22 . As surgeons lack tactile feedback during robotic surgery, it was not easy to determine the tightness of the PG sutures early in the surgery.…”

“…PG was easy to accomplish and did not influence the normal structure of the digestive tract greatly. 22 As surgeons lack tactile feedback during robotic surgery, it was not easy to determine the tightness of the PG sutures early in the surgery. Free splenic artery and splenic vein were usually required in spleen-preserving RDP and surgeons needed to deal with small branches on the splenic vessels.…”

Update on the Surgical Treatment of Pancreatic Neuroendocrine Tumors

“…In the area of robotic surgery, few teams have reported their preliminary experience of robot-assisted pancreatectomy (78,79) with encouraging results. Further studies are now required to better assess the role of the robotic approach in pancreatic surgery.…”

Comparison of robotic and open central pancreatectomy

“…6,8 So far, only a handful of reports on robotic central pancreatectomy (RCP) exist in the literature, and most of them describe just a single case or a small number cases. 2,4,[9][10][11][12][13][14][15][16][17] The aim of this study was to clarify the feasibility, safety, and rate of postoperative complications after RCP, compared to those of the traditional open central pancreatectomy (OCP). Furthermore, the pancreatic endocrine and exocrine functions were also evaluated after RCP and OCP.…”