Robotic pancreaticoduodenectomy for a large pancreatic neuroendocrine tumor

Abstract

Presenter: Ming Cui | Johns Hopkins University School of Medicine Background: A 44-year-old female who complained of right upper quadrant pain radiating to her back for three months was evaluated in our hospital. Her past medical history included ulcerative colitis (UC) and chronic migraine. Her past surgery history included open cesarean-section, tubal ligation, and abdominoplasty. Abdominal enhanced CT showed a heterogeneously enhancing 7.4×7.9 cm mass arising from pancreatic head with areas of cystic degeneration and calcification which was not closely involved with surrounding vasculature. No biliary or pancreatic ductal dilatation was found. A fine needle aspiration biopsy under endoscopic ultrasound (EUS) was performed for the patient at outside hospital and pathologic diagnosis was considered as well-differentiated neuroendocrine tumor. Methods: After discussion with the patient, robotic Whipple procedure was recommended. Da Vinci Xi system was used for the surgery. One 10mm assisting trocar and four 8mm robotic trocars were placed. Results: A large tumor with largest dimension of 8 cm was revealed in the head of pancreas during the surgery, pushing superior mesenteric vein (SMV) to the medial side. Extensive Kocher maneuver was performed to mobilize this large tumor in the head of the pancreas and duodenum out of the retroperitoneum. Finally, a robotic pancreaticoduodenectomy (Whipple procedure) was successfully performed for this patient. Postoperative pathology showed a well-differentiated pancreatic neuroendocrine tumor (8×6.5×6.4 cm, WHO grade 1). Margins and twenty-three lymph nodes were both negative for tumor. Pathologic tumor stage is pT3 pN0. The patient progressed well after the surgery. Surgical drain was removed on postoperative day (POD) 6 and the patient was discharged to home in good condition on the same day. The patient is doing well at the follow up in 3 weeks after discharge. Conclusion: This experience demonstrates the feasibility and safety of robotic pancreaticoduodenectomy for large pancreatic neuroendocrine tumors.