Alessandra Marano, Giorgio Giraudo, Stefano Giaccardi, Desiree Cianflocca, Diego Sasia, Felice Borghi. Santa Croce e Carle Hospital
INTRODUCTION: Pancreas-sparing resections would be the ideal procedure in case of small pancreatic neuroendocrine tumors (p-NETs) reducing the risk of exocrine and endocrine insufficiency. Compared to standard resection, this type of surgery is safe and feasible without increasing the risk of postoperative complications except the overall rate of clinical pancreatic fistula (PF), which did not result in higher mortality or overall morbidity. Robotic surgery for pNETs enucleation has been rarely described but initials experiences have shown that this approach is associated with favorable outcomes. The aim of this study is to describe three cases of dV®Si™ pancreatic enucleation for p-NETs located in the uncinate process, in the body and in the posterior aspect of the tail of the pancreas, respectively. A brief review of the literature regarding the application of robotics for pNETs enucleation is also included.
METHODS AND PROCEDURES: This study includes patients undergoing dV®Si™ enucleation for pNETs with a maximum diameter no more than 2cm and a distance between tumour and main pancreatic duct (MPD) greater than 2 mm. At surgery, exposure of the pancreas was achieved by separation and traction of the gastrocolic and gastropancreatic ligaments. The pancreas was explored: an intraoperative ultrasound was used ensuring negative margins and leaving the MPD intact. Thus, a cross-stitch through the tumour was made routinely in order to pull the tumour. Enucleoresection was carried out with monopolar scissors and bipolar forceps. The tumour was placed into a specimen bag and removed from the trocar port. A drain was always left.
RESULTS: Median total operative time was 178 min. No conversion neither intraoperative complications occurred. Median length of stay was 4.6 days. Two patients presented a PF grade A (classification ISGPF) while a PF grade B occurred in case of pancreatic tail NET enucleation. Final pathology revealed two insulinomas and one non-functioning NET of the pancreatic body. At a median follow-up of 15 months no pancreatic insufficiency, reoperation or tumour reoccurrence was observed in all cases.
CONCLUSION(S): The robotic approach for the treatment of p-NETs is safe and feasible and, in selected cases, it may extend the indications of minimally invasive pancreatic-sparing surgery. In particular, the robotic approach provides a more precise dissection and may ensure negative margins and the MPD intact. These preliminary results are consistent with literature data about over 100 robotic pancreatic enucleations for p-NETs that shows favourable surgical outcomes, especially if compared with those of open surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87369
Program Number: P802
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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