PM is a rare medical problem. PM accounts for 2% to 11% [3,4,5] of pancreatic tumors. However, RCC is the most common primary cancer that metastasizes to the pancreas [5,6]. Still, RCC rarely metastasizes to the pancreas and represents only <5% of all metastatic RCC [7]. Pancreatectomy is the treatment of choice for RCC-PM with acceptable outcomes [1,2,6,8]. Lymphadenectomy in the context of RCC-PM remains a controversial issue [2,9]. In this context, organ-sparing pancreatectomy deserves consideration.

Generally, the numbers and location of PM are important factors in deciding the operative plan. The tumor at body to tail of pancreas deserves the spleen-preserved DP or enucleation as a preferred option due to the organ-sparing concept. However, conventional DP with splenectomy is considered if the technique is not safe to preserve the spleen and splenic vessels. The tumor at HOP, a small subcapsular lesion might be considered enucleation as a first choice if the transection line is away from MPD and CBD otherwise most cases need PD as a suitable option. The multifocal PMs involve the head, body, or tail of the pancreas, the extended PD or extended DP should be considered as a first option to preserve endocrine function as much as possible. However, if not total pancreatectomy is the last option.

In this case, one tumor at HOP is located near MPD and CBD. Therefore, the possible operative plans included either subtotal left pancreatectomy with spleen preservation or total pancreatectomy. To enhance recovery, a minimally invasive pancreatectomy was preferred. In comparison with the laparoscopic approach, the robotic approach is associated with a higher success rate of spleen-preserved DP [10]. In addition, the endo-wrist and three-dimensional magnified laparoscopy of the robot system make the pancreatic parenchymal transection at HOP under ultrasound guidance precise, avoiding CBD injury, and safe closure MPD. In this article, we demonstrated the organ-sparing technique of robotic subtotal left pancreatectomy which conserved distal CBD and pancreatic parenchyma at HOP, and uncinate process. Compared with total pancreatectomy, this operation should be associated with a lower rate of long-term complications related to brittle diabetes and hepaticojejunostomy stricture. In conclusion, robotic complex pancreatectomy is feasible and safe in selected cases. The robot-assisted technique is helpful in increasing the success rate of the organ-sparing pancreatectomy.