[A Case of Robot-Assisted Distal Pancreatectomy Performed for High-Grade PanIN]

In recent years, advancements in diagnostic techniques have led to occasional reports of surgical resection cases for pancreatic cancer initially identified as carcinoma in situ. High-grade pancreatic intraepithelial neoplasia(PanIN)is considered equivalent to carcinoma in situ, and early intervention for this lesion holds potential for significantly improving patient outcomes. In our institution, we have adopted minimally invasive approaches including laparoscopic distal pancreatectomy (LDP)since April 2010 and robot-assisted distal pancreatectomy(RDP)since September 2020. Here, we report a case where RDP was performed in September 2023 for a male patient in his 70s with suspected pancreatic body cancer and main pancreatic duct stricture confirmed on endoscopic retrograde cholangiopancreatography(ERCP). Despite normal tumor marker levels, surgical resection was deemed necessary. Postoperative pathology revealed high-grade PanIN without lymph node involvement. The patient experienced a pancreatic fistula postoperatively, managed with endoscopic ultrasonography-guided transmural drainage, and was discharged after 36 days. As of 10 months post-surgery, the patient remains disease-free. In this report, we present our experience of RDP for high-grade PanIN. Further accumulation of cases and investigation are necessary for the diagnosis of PanIN and the indications for surgical resection.