A case of successfully completed robot-assisted distal pancreatectomy for pancreatic tail cancer in a patient with prior colostomy: case report.

Introduction: Pancreatic cancer may invade the colon, resulting in bowel obstruction and requiring the patient to undergo colostomy. Open surgery is often the treatment of choice for patients with colostomy, but we successfully and safely performed a robot-assisted distal pancreatectomy. Case presentation: The patient was a 55-year-old woman diagnosed with pancreatic tail cancer invading the left kidney and transverse colon. She underwent a transverse colostomy because of a colonic obstruction associated with colon invasion. She then received gemcitabine plus nab-paclitaxel, followed by modified FOLFIRINOX. After imaging confirmed tumour shrinkage, a robot-assisted distal pancreatectomy, transverse colon resection, and colostomy closure were planned. A partial colon resection, including colostomy, was performed first. As a result, robot-assisted surgery was possible with the usual field of view and port placement. During this procedure, the pancreatic tail, spleen, transverse colon (including invasive pancreatic cancer lesion), left adrenal gland, and part of the left kidney were resected en bloc. Finally, reconstruction of the colon was performed. The patient recovered well postoperatively and was discharged on postoperative day 9 with no complications. The patient has been recurrence-free for 2 months after surgery. Conclusion: This case demonstrates that robot-assisted distal pancreatectomy is feasible in selected patients with pancreatic cancer and prior colostomy.