Ann Hepatobiliary Pancreat Surg.  2020 Feb;24(1):97-103. 10.14701/ahbps.2020.24.1.97.

Robotic enucleation of a pancreatic uncinate neuroendocrine tumor – a unique parenchyma-saving strategy for uncinate tumors

• Chin KM
• Goh BK

• KMID: 2471197
• DOI: http://doi.org/10.14701/ahbps.2020.24.1.97

Abstract

Pancreatic neuroendocrine tumors (PNET) comprise up to 10% of all pancreatic solid tumors. There has been much interest in recent years with regards to the role of limited resection and enucleation procedures for this entity. There is no clear guideline today on the optimal type choice of surgery for this condition, with even fewer reporting on the use of a robotic approach for pancreatic uncinate lesions. We describe a case report of a 54-year-old lady who underwent successful robotic enucleation of pancreatic uncinate neuroendocrine tumor. This patient's recovery was complicated by pancreatitis and a peripancreatic collection, both of which resolved without surgical re-intervention. A literature review was performed with regards to current guidelines on management of PNETs, comparisons between demolitive and parenchymal-preserving procedures, and recent developments in the laparoscopic and robotic approaches for this condition. There is no clear guideline on the optimal type and approach (open vs. laparoscopic vs. robotic) to the surgical management of PNET. We document in this case report a novel approach of robotic enucleation of pancreatic uncinate process NET, that could be considered as an alternative to open/laparoscopic demolitive procedures for small uncinate tumors.

Keyword

Pancreas; Uncinate; Neuroendocrine; Robotic; Enucleation

MeSH Terms

Humans
Middle Aged
Neuroectodermal Tumors, Primitive
Neuroendocrine Tumors*
Pancreas
Pancreatitis

Figure

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  Fig. 1 (A) Ultrasound of the hepatobiliary system showing a 2.2×1.8×1.5 cm isoechoic lesion within the pancreatic uncinate process with non-dilated pancreatic duct. (B) Computer tomography of the pancreas showing a solid hypervascular mass measuring 1.7×1.5×1.3 cm in the posteromedial aspect of the pancreatic uncinate process with no invasion into adjacent structures. There is no suspicious lymphadenopathy identified. (C) Magnetic resonance cholangiopancreatography confirming findings of ultrasound hepatobiliary system and computer tomography of the pancreas with a measured distance of 4 mm between the uncinate process tumor and the adjacent non-dilated main pancreatic duct. (D) Position emission tomography-Computer tomography shoring a fluorodeoxyglucose-avid mass in the pancreatic uncinate process suspicious for neuroendocrine tumor with no distant sites of metastasis.

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  Fig. 2 (A) Endoscopic retrograde cholangiopancreatography with endoscopic ultrasound showing a 1.7×1.0 cm hypoechoeic uncinate process mass with no extension into surrounding structures. (B) 5 French×8 cm Cook Zimmon® single pigtail plastic stent was deployed and unflanged within main pancreatic duct.

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  Fig. 3 Relationship of pancreatic uncinate mass to surrounding structure and depicting the extent of resection.

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