Robotic Pancreatectomy as an Adjunct to Radical Gastrectomy for Advanced Gastric Cancer: Surgical and Clinical Implications.

[BACKGROUND] The integration of robotic pancreatectomy into radical resections for advanced gastric cancer (AGC) is a novel and underexplored area, offering potential benefits for both patient outcomes and healthcare systems. We report two cases of AGC with pancreatic invasion, managed through robotic pancreatectomy in combination with gastrectomy, enabled by a collaborative effort between upper GI and pancreatic surgeons.

[METHODS] In the first case, a 75-year-old woman with gastric outlet obstruction due to advanced gastric cancer underwent gastric bypass followed by four cycles of neoadjuvant SOX plus trastuzumab. Robotic pancreaticoduodenectomy was subsequently performed alongside distal gastrectomy with D2 lymphadenectomy, addressing pancreatic head invasion. Postoperative recovery was uneventful, with minimal pain and early resumption of oral intake. She remains disease-free 21 months after treatment.

[RESULTS] The second case involved a 66-year-old woman diagnosed with upper gastric cancer with pancreatic body invasion. After achieving a favorable response to four cycles of SOX plus nivolumab, she underwent robotic distal pancreatectomy along with total gastrectomy. Her recovery was smooth, enabling the seamless initiation of adjuvant therapy. She remains recurrence-free 24 months posttreatment.

[CONCLUSIONS] These cases underscore the advantages of a fully robotic approach, including enhanced surgical precision, faster recovery, and preserved quality of life. By enabling pancreatic surgeons to perform complex resections robotically, this strategy encourages upper gastrointestinal surgeons to adopt robotic gastrectomy for advanced cases. Avoiding open conversion reduces the need for additional healthcare resources, underscoring the value of robotic surgery in advancing both patient-centered care and cost-effective cancer management..