Robotic Appleby procedure for recurrent pancreatic cancer

Background: A 49-year-old male being followed for a small pulmonary lung nodule underwent computed tomography (CT) in September 2018 and was found to have pancreatic duct dilatation and atrophy of the pancreatic tail. A subsequent endoscopic ultrasound (EUS) and biopsy confirmed adenocarcinoma. The patient was included in our neoadjuvant trial. He was started on systemic treatment in February 2019 and tolerated it well. Methods: The group agreed to proceed with surgery. The patient underwent a distal pancreatectomy and splenectomy in June 2019. Results: He had a good treatment response, with a 50% response. None of the 12 lymph nodes had the disease: T2 N0. He was restarted on systemic therapy. He finished chemotherapy (FOLFIRINOX) in November 2019. He remained stable for almost 2 years. A CT scan performed in September 2021 showed a small soft tissue mass measuring 2.8 × 2.1 cm around the distal celiac trunk, and common hepatic artery A positron emission tomography scan performed on Dec. 8, 2021, showed a 3 cm soft-tissue mass around the celiac trunk. An EUS was performed, and the biopsy was positive for adenocarcinoma. Conclusion: The patient received chemotherapy and an angiography, which revealed a good flow through the liver via the gastroduodenal artery. The patient underwent a modified robotic Appleby procedure.