# Robotic Distal Pancreatectomy for Adult Pancreatoblastoma with Tumor Extension to the Main Pancreatic Duct: A Case Report

## TL;DR

This case report describes the first use of robotic surgery to successfully remove a rare adult pancreatoblastoma tumor extending into the main pancreatic duct.

## Contribution

The first reported use of robotic surgery for adult pancreatoblastoma with tumor extension into the main pancreatic duct.

## Key findings

- Robotic surgery enabled precise resection of the tumor with a negative pancreatic transection margin.
- The pancreatic stump was safely closed using robotic techniques, resulting in an uneventful postoperative recovery.
- The case highlights the potential clinical relevance of robotic surgery for complex pancreatoblastoma resections.

## Abstract

Adult pancreatoblastoma (PB) is an extremely rare malignant pancreatic epithelial tumor. Although no standard treatment strategy has been established, complete resection is recommended for long-term survival. Here, we presented a case of an adult patient with PB who successfully underwent complete resection via robotic surgery. Furthermore, this is the first report of robotic surgery for PB, highlighting its novelty and potential clinical relevance.

A 40-year-old man presented with epigastric pain, and image examination revealed a well-defined tumor in the pancreatic tail extending into the main pancreatic duct (MPD) and reaching the pancreatic neck. With no evidence of distant metastases, surgery was planned following 2 courses of gemcitabine and S-1 chemotherapy for tumor shrinkage. There were no significant changes in the tumor’s extension after chemotherapy, but no new lesions appeared, and robotic distal pancreatectomy was performed. Intraoperative findings confirmed the tumor extension into the MPD just above the superior mesenteric vein (SMV). The pancreas was sharply divided at the right edge of the SMV, and a negative transection margin was obtained. The pancreatic stump was closed by suture. The postoperative course was uneventful, and the pathological diagnosis confirmed PB with MPD and inferior mesenteric vein invasion.

We successfully resected an adult case of PB with tumor extension into the MPD via robotic surgery. Robotic surgery enabled precise pancreatic transection at the right edge of the SMV, ensuring a negative pancreatic transection margin in this case. In addition, robotic surgery contributed to the safe and secure suture closure of the pancreatic stump.