Robotic Whipple procedure for a branch duct intraductal papillary mucinous neoplasm: a case report

Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic cystic neoplasm that has a relevant prevalence among asymptomatic general population and may turn into a malignant lesion. The most appropriate time for its surgical resection is still in debate. However, there have been few studies that share experiences that assess their alignment with major guidelines on the topic. In our case, we achieved favorable outcomes using surgical criteria outlined in the Fukuoka consensus guidelines and a roboticassisted Whipple procedure for the treatment of a branch duct IPMN. We describe the case of a 56-year-old woman, asymptomatic, with unremarkable physical exam, who was referred for a cystic lesion in the head of the pancreas. Magnet resonance imaging and magnetic resonance cholangiopancreatography showed criteria of high risk of malignant transformation. It was considered that the most desirable conduct for the patient would be a robotic-assisted cephalic duodenopancreatectomy associated with distal partial gastrectomy, cholecystectomy and retroperitoneal lymphadenectomy. Microscopic examination confirmed the diagnosis of a branch duct IPMN with adenocarcinoma foci. No postoperative complications were reported and the patient went through adjuvant chemotherapy. The minimally invasive surgery may be considered as a valid approach for IPMN suspected patients, plausibly resulting in favorable oncological outcomes. Furthermore, our experience is aligned with the Fukuoka consensus guidelines, which was found to be a great tool to predict malignancy and to consider surgical resection.