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

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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.

Author information

Correspondence to Patrick Pessaux MD, PhD.

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DISCLOSURE

The authors have no conflicts of interest or financial ties to disclose.

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Wakabayashi, T., Felli, E., Cherkaoui, Z. et al. Robotic Central Pancreatectomy for Well-Differentiated Neuroendocrine Tumor: Parenchymal-Sparing Procedure. Ann Surg Oncol 26, 2121 (2019). https://doi.org/10.1245/s10434-019-07387-8

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