To investigate the short-term clinical effect of robotic radical pancreatosplenectomy for high-risk recurrent resectable pancreatic cancer after neoadjuvant therapy, summarize the technical aspects and key points, and discuss the recent clinical effects.

The data of a patient treated in the Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army(PLA)General Hospital were retrospectively analyzed. A 52-year-old female was diagnosed with pancreatic tail tumor. CA19-9 level was 1902 U/ml. MRI showed a hypovascular tumor in the pancreatic tail with the maximum diameter of 41mm. PET-CT showed a hypermetabolic mass in the pancreatic tail with SUVmax: 7.1, and pancreatic cancer was considered. Small lymph nodes in the pancreaticogastric space with mild metabolism were suspected to metastasize. The patient was diagnosed with pancreatic tail cancer (cT2N1M0, resectable, high risk of recurrence). The patient was received 4 cycles of neoadjuvant therapy with gemcitabine, albumin-bound paclitaxel and PD-1 inhibitor. After treatment, CA19-9 level decreased to 272.6 U/ml, the maximum diameter of tumor decreased to 26 mm, SUVmax level decreased to 2.8, and the metabolism of lymph nodes in the pancreaticogastric space disappeared. RECIST criteria assessed a partial response. Robotic radical pancreatosplenectomy combined with partial gastric wall resection was performed.

The operation was completed successfully, and the operation time was 265 min and the blood loss was 100 ml. The pathological diagnosis was moderately differentiated adenocarcinoma (pT2N0M0). The patient was discharged 11 days after operation. After 2 cycles of treatment, there was no tumor recurrence or metastasis during the follow-up of 18 months.

Robotic radical pancreatosplenectomy is safe and feasible in the treatment of high-risk recurrent pancreatic cancer after neoadjuvant therapy.