This operative video demonstrates a robotic completion total pancreatectomy and splenectomy performed for locally recurrent pancreatic ductal adenocarcinoma (PDAC) following prior pancreatic resection and systemic therapy.

The patient is a 71-year-old man who initially presented with borderline resectable pancreatic cancer involving the pancreatic head, classified as type A due to tumor–vascular interface and type B due to elevated tumor marker CA 19-9. He completed eight cycles of neoadjuvant FOLFIRINOX, demonstrating a favorable radiographic response.

He subsequently underwent a robotic pancreaticoduodenectomy with vascular reconstruction. Final pathology demonstrated ypT1 ypN0 pancreatic ductal adenocarcinoma with 0 of 19 lymph nodes involved and negative surgical margins. The patient then completed four additional cycles of adjuvant FOLFIRINOX, completing a total of 12 cycles of systemic therapy.

During postoperative surveillance, imaging identified a new mass in the body of the pancreas, which was biopsy-proven locally recurrent pancreatic ductal adenocarcinoma.

The patient underwent robotic staging laparoscopy followed by completion total pancreatectomy and splenectomy. Intraoperative ultrasound (IOUS) was used to evaluate pancreatic and vascular anatomy.

The pathology demonstrated pT2 pN1 moderately differentiated pancreatic ductal adenocarcinoma with 2 of 15 lymph nodes involved and negative surgical margins.

The patient recovered well following surgery and was discharged home on postoperative day four, with pancreatic enzyme replacement therapy (PERT) and insulin therapy initiated for management of endocrine and exocrine insufficiency.

This case illustrates the application of advanced robotic techniques in complex pancreatic reoperative surgery within a multidisciplinary hepatopancreatobiliary oncology program.