Robotic Portal Tumor Thrombectomy during Pancreatoduodenectomy for Acinar Cell Carcinoma

BACKGROUND: Acinar cell carcinoma (ACC) of the pancreas is a rare malignant tumor that accounts for 1%-2% of all pancreatic neoplasms. The prognosis of ACC is better than that of ductal carcinoma (PDCA), with a 5-year survival rate of 36.2% to 72.8% in resected patients. Therefore, rigorous surgical resection with negative margins should be pursued.

METHODS: We present a video of a 73-year-old man with a 7-cm solid acinar cell carcinoma in the head of the pancreas. MRI showed no dilatation of the bile duct or pancreatic duct, but a neoplastic thrombus was detected in the porto-mesenteric vein. The multidisciplinary team decided to perform an upfront resection. We proposed a robotic approach and received approval.

RESULTS: The total operative time was 340 minutes with an estimated blood loss of 120 ml. Resection time was 224 minutes and venous reconstruction took 27 minutes. Recovery was uneventful and the patient was discharged on postoperative day 6. The patient’s pathology confirmed an acinar cell carcinoma 7.0 cm in size with free margins. Stage T3N1 (1/39).

CONCLUSION: Acinar cell carcinoma has a better prognosis than PDAC, therefore resection should be attempted even in patients with a tumor thrombus that can be safely operated on with the robotic platform.