Abstract

Purpose: We present the case of a 45 years old patient with a diagnosis of a single resectable 12mm histologically proved G1 NET of the pancreatic isthmus. Method: In her past medical hystory we notice a laparoscopic gastric by-pass was performed for morbid obesity. Pre-operative work-up included pancreatic MRI, thoracic CT-scan and blood exams. Chromogranine A was within limits. After multidisciplinary discussion either resection or surveillance were conceived considering size and grading, the patient preferred surgical resection in order to avoid life-long surveillance and because of the fear of having a pancreatic lesion potentially evolving. A robotic minimally invasive approach was then considered, the surgical strategy focused on the distal pancreatic stump anastomosis. Results: Intraoperative ultrasound confirmed the absence of other pancreatic lesions. A pancreatico-gastric anastomosis was performed on the excluded stomach, tutored by an Escat drain exteriorized according to Voelker. Post-operative course was uneventful, the patient was discharged on postoperative day 9 (POD9),Pathological findings: grade 1 well-differentiated neuroendocrine tumor, Ki-67 index <1%, R0 (complete resection) Escat drain clamped on POD 14 and withdrawn 1 month after the operation. Conclusion: robotic central pancreatectomy allowed a very precise dissection with the possibility of an ergonomic pancreatico-gastric anastomosis.

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