Solid pseudopapillary pancreatic tumors of pancreas are a rare entity, seen most often in females in their second or third decades. Although previously believed to be benign, this tumor is currently considered a low-grade malignant epithelial neoplasm with low metastatic rate and high overall survival.1,2 Its resection could be performed by robotic technique with respect to oncological principles to avoid tumor cell dissemination.3
In this multimedia article, we present a 28-year-old female with a history of hyperthyroidism who underwent a computed tomography (CT) scan because of a persistent high C-reactive protein level following caesarean section. This CT scan revealed a 7-cm cystic lesion of the pancreatic tail. The serum tumor marker CA 19-9 was normal. Further investigation with an magnetic resonance imaging (MRI) scan showed that the lesion was macrocystic with internal septas compatible with a solid pseudopapillary neoplasm.4 The patient was treated with robotic distal splenopanceatectomy (video).
The operative time was 5 h with an estimated blood loss of 250 mL. No blood transfusion was necessary. The postoperative period was uneventful, and she was discharged on postoperative day 8. The histological finding revealed a solid pseudopapillary tumor of the pancreas pT2pN0 (0/14 lymph nodes removed). There was no evidence of clinical, biological, and radiological pancreatic fistula, and a control CT scan on postoperative day 8 did not show any abdominal fluid collection. The patient’s 1 month follow-up was normal.
The robotic distal splenopancreatectomy is a procedure that offers some technical and oncological advantages over the already described minimally invasive techniques for distal pancreatic tumors.5,6 These advantages are mainly due to the stability of the operative field, to the 3D and magnified vision, and to the articulated robotic arms.7–9 The 3D representation and the stability of the operative field facilitate the performance of operative steps, as the creation of the retropancreatic tunnel and vascular identification. Moreover, the robotic articulated arms permit a superior handling of vascular structures, allowing a fine dissection that is extremely useful during lymphadenectomy. Articulated instruments easily achieve the correct rotation axis, thus minimizing peri-pancreatic tissue retraction and manipulation of the pancreatic gland. This smooth and no-touch technique in theory minimizes the risk of pancreatic capsule rupture as well as tumor cell dissemination, respecting oncological surgical standards. However, robotic surgery needs an adequate learning curve, especially concerning the installation and the lack of force feedback.
The robotic distal pancreatectomy is a possible minimally invasive technique for patients with solid pseudopapillary pancreatic tumors. It presents some advantages over the laparoscopic approach. Nevertheless its oncological indications are yet to be defined.10
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J Am Coll Surg. 2005;200:965–72.
Canzonieri V, Berretta M, Buonadonna A, Libra M, Vasquez E, Barbagallo E, et al. Solid pseudopapillary tumour of the pancreas. Lancet Oncol. 2003;4:255–6.
Yu PF, Hu ZH, Wang XB, Guo JM, Cheng XD, Zhang YL, et al. Solid pseudopapillary tumor of the pancreas: a review of 553 cases in Chinese literature. World J Gastroenterol. 2010;16: 1209–14.
Mortenson MM, Katz MH, Tamm EP, Bhutani MS, Wang H, Evans DB, et al. Current diagnosis and management of unusual pancreatic tumors. Am J Surg. 2008;196:100–13.
Borja-Cacho D, Al-Refaie WB, Vickers SM, Tuttle TM, Jensen EH. Laparoscopic distal pancreatectomy. J Am Coll Surg. 2009;209:758–65.
Khanna A, Koniaris LG, Nakeeb A, Schoeniger LO. Laparoscopic spleen-preserving distal pancreatectomy. J Gastrointest Surg. 2005;9:733–8.
Vasilescu C, Sgarbura O, Tudor S, Herlea V, Popescu I. Robotic spleen-preserving distal pancreatectomy. A case report. Acta Chir Belg. 2009;109:396–9.
Giulianotti PC, Sbrana F, Bianco FM, Addeo P, Caravaglios G. Robot-assisted laparoscopic middle pancreatectomy. J Laparoendosc Adv Surg Tech A. 2010;20:135–9.
Ntourakis D, Marzano E, Lopez Penza PA, Bachellier P, Jaeck D, Pessaux P. Robotic distal splenopancreatectomy: bridging the gap between pancreatic and minimal access surgery. J Gastrointest Surg. 2010;14:1326–30.
Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010;24:1646–57.
Conflict of interest
The authors indicated no potential conflicts of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Ntourakis, D., Marzano, E., De Blasi, V. et al. Robotic Left Pancreatectomy for Pancreatic Solid Pseudopapillary Tumor. Ann Surg Oncol 18, 642–643 (2011). https://doi.org/10.1245/s10434-010-1376-6
- Distal Pancreatectomy
- Laparoscopic Distal Pancreatectomy
- Solid Pseudopapillary Tumor
- Tumor Cell Dissemination
- Pancreatic Gland