Supplementary Material for: Robot-Assisted Simultaneous Distal Pancreatectomy and Sigmoidectomy for Synchronous Pancreatic and Colon Tumors: A Case Report

Introduction:
With advancements in cancer diagnostics and treatment, the detection of multiple primary tumors has become more common, prompting the need for effective and minimally invasive surgical strategies. Simultaneous multiorgan resections can reduce surgical stress and promote early postoperative recovery, which is particularly beneficial when timely initiation of adjuvant therapy is essential. Robot-assisted surgery offers enhanced precision and dexterity, making it a valuable option for complex multivisceral resections. In this case, we performed simultaneous robot-assisted pancreatic resection and colectomy in a patient who also required curative chemoradiotherapy for esophageal cancer, allowing for the prompt initiation of postoperative treatment.
Case Presentation:
The patient was a 76-year-old man diagnosed with a neuroendocrine tumor in the pancreatic tail, early-stage esophageal squamous cell carcinoma, and early-stage sigmoid colon adenocarcinoma. Surgical indications were confirmed for all three lesions. A multidisciplinary team decided to perform simultaneous robot-assisted distal pancreatectomy and sigmoidectomy using the da Vinci® Xi system, followed by curative chemoradiotherapy for the esophageal cancer. We minimized the number of additional ports (total of seven) by sharing some between the two procedures, while maintaining optimal instrument maneuverability. The total operative time was 375 minutes (console time, 265 minutes), with no perioperative complications. The patient was discharged on postoperative day 12 and subsequently underwent chemoradiotherapy for esophageal cancer.
Conclusion:
This case highlights the feasibility and safety of robot-assisted simultaneous distal pancreatectomy and sigmoidectomy. While robotic multivisceral resections offer several advantages, thorough preoperative planning, surgical expertise, and appropriate patient selection remain essential.