Robotic distal pancreatectomy with celiac axis resection for locally advanced pancreatic cancer

With improved outcomes following the addition of neoadjuvant therapy some surgeons have taken an aggressive approach to operating on patients with locally advanced pancreatic cancer with vascular involvement. A modified Appleby operation has been described for lesions of the body or tail of the pancreas with celiac axis involvement and includes distal pancreatectomy and splenectomy with en bloc celiac axis resection (DP-CAR). Efforts to improve the safety of pancreatectomy have led to the development and implementation of minimally invasive and robotic approaches to pancreatectomy. Herein we review our experience with robotic DP-CAR.