Tomita Koichi, Maxwell Jessica E, Snyder Rebecca A, Kim Michael P, Tran Cao Hop S, Tzeng Ching-Wei D, Katz Matthew H G, Ikoma Naruhiko
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2025 Jun;32(6):4128-4129. doi: 10.1245/s10434-025-17028-y. Epub 2025 Mar 5.
Central pancreatectomy (CP) is one of the parenchyma-sparing approaches proposed for low-grade tumors. CP has a lower incidence of diabetes compared with distal pancreatectomy, but may harbor risks of positive distal pancreatic margin, inadequate lymph node (LN) removal, and pancreatic fistula from the pancreaticojejunal anastomosis. Given the reported oncologic safety, we selectively perform CP for small pancreatic neuroendocrine tumors (pNETs) that are localized to the pancreatic neck. A robotic surgical approach with augmented skills can perform a CP procedure in a minimally invasive fashion; however, a standard surgical procedure for robotic CP has not yet been established. A key safety consideration when performing CP is to avoid injury to the dorsal pancreatic arteries, which supply blood to the pancreatic neck. We report on a robotic CP in a 59-year-old male with a 2.2 cm nonfunctional, clinically node-negative pNET localized to the pancreatic neck. The pancreatic tail showed a large volume. After discussing the risks and benefits, the patient underwent a robotic CP. Following tumor localization at the pancreatic neck via ultrasound, we transected the proximal neck using a stapler. We then continued dissection of the hepatic and splenic arteries, and the dorsal pancreatic artery, originating from the splenic artery, was securely clipped. After transection of the pancreatic body, the Roux limb was elevated through the left mesocolic window to complete the pancreaticojejunostomy. Recovery was favorable, without incidence of diabetes. The pathological findings were a well-differentiated neuroendocrine tumor, without LN involvement.In summary, robotic CP with regional LN dissection can be safely performed for small pNETs, without lymphadenopathy.
中央胰腺切除术（CP）是为低级别肿瘤提出的保留实质的手术方法之一。与远端胰腺切除术相比，CP导致糖尿病的发生率较低，但可能存在胰腺远端切缘阳性、淋巴结（LN）清扫不充分以及胰肠吻合口胰瘘的风险。鉴于已报道的肿瘤学安全性，我们选择性地对局限于胰腺颈部的小胰腺神经内分泌肿瘤（pNETs）施行CP。具备增强技能的机器人手术方法能够以微创方式施行CP手术；然而，机器人CP的标准手术流程尚未确立。施行CP时一个关键的安全考量是避免损伤为胰腺颈部供血的胰背动脉。我们报告了一例为一名59岁男性施行的机器人CP手术，该患者有一个2.2厘米大小、无功能、临床检查淋巴结阴性的pNET，局限于胰腺颈部。胰腺尾部体积较大。在讨论了风险和益处后，患者接受了机器人CP手术。通过超声确定肿瘤位于胰腺颈部后，我们用吻合器横断胰腺颈部近端。然后继续解剖肝动脉和脾动脉，发自脾动脉的胰背动脉被牢固夹闭。横断胰体后，将Roux袢经左结肠系膜窗提起以完成胰肠吻合术。恢复情况良好，未发生糖尿病。病理检查结果为高分化神经内分泌肿瘤，无淋巴结受累。总之，对于无淋巴结病变的小pNETs，可安全地施行机器人CP并进行区域LN清扫。
