AI Article Synopsis
- RPD can be effectively performed for complex cases of borderline-resectable pancreatic tumors with portal vein involvement and unusual arterial anatomy.
- A 75-year-old female patient with pancreatic head cancer underwent robotic pancreaticoduodenectomy after preoperative chemotherapy improved her condition.
- The surgery successfully managed bleeding risks and achieved clear surgical margins, with the patient recovering well and being discharged after 8 days.
Article Abstract
Background: Robotic pancreaticoduodenectomy (RPD) is performed for resectable periampullary lesions with comparable outcomes to the open approach.1 Surgical therapy for borderline-resectable (BR) pancreatic tumors is technically challenging and poses a significant risk of bleeding and positive margins.2 As experience with RPD grows at high-volume centers, case selection can be carefully expanded to include complex vascular resections.3 We demonstrate a RPD performed for BR pancreatic adenocarcinoma with portal vein (PV) involvement and presence of anomalous hepatic arterial anatomy.
Methods: A 75-year-old female presented with abdominal pain and obstructive jaundice. She was previously healthy and had a relatively normal body mass index (25.7 kg/m). Endoscopic ultrasound and computed tomography imaging identified a pancreatic head mass measuring 2.3 cm with evidence of concomitant abutment of the PV (90-180 degree) and abutment of a replaced right hepatic artery (rRHA) originating from the superior mesenteric artery (SMA). Following four cycles of neoadjuvant gemcitabine/nab-paclitaxel, restaging imaging demonstrated partial radiographic response, represented by a lesser degree of PV abutment and resolution of rRHA abutment. RPD was performed with side-bite resection of the PV and preservation of rRHA. The video demonstrates the key steps followed in a robotic pancreaticoduodenectomy performed for a technically challenging pancreatic head cancer and highlights robotic control of bleeding from the PV and SMA obviating the need for conversion. Histopathology revealed a residual moderately differentiated ductal adenocarcinoma with 4-of-40 positive lymph nodes and negative surgical margins. The tumor was staged as ypT1cN2 (AJCC 8 edition). The patient had an uneventful postoperative course and was discharged on hospital day 8.
Conclusion: In high-volume centers, the robotic approach can be safely used in selected cases of technically challenging BR pancreatic head cancers.
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| http://dx.doi.org/10.1007/s11605-021-04937-y | DOI Listing |
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