Feasibility and Safety of Laparoscopic Radical Distal Pancreatosplenectomy with Adrenalectomy in Advanced Pancreatic Can
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Feasibility and Safety of Laparoscopic Radical Distal Pancreatosplenectomy with Adrenalectomy in Advanced Pancreatic Cancer Seung Soo Hong, MD1,2, Ho Kyung Hwang, MD, PhD1,2, Woo Jung Lee, MD, PhD1,2, and Chang Moo Kang, MD, PhD1,2 1 2
Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea; Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
ABSTRACT Introduction. Pancreatic adenocarcinoma is a lethal condition with poor outcomes and an increasing incidence.1 However, recent meta-analysis reported improved survival and R0 resection rate following neoadjuvant chemotherapy with subsequent surgery in initially unresectable pancreatic cancer.2 In addition, as a result of technological advances during the past 2 decades, even in pancreatic cancers, minimally invasive surgery (MIS) approaches are being used more frequently and safely.3–5 This video shows the feasibility and safety of laparoscopic resection in advanced left-sided pancreatic cancer. Method. The patient was a 63-year-old male with hypertension and diabetes. Initial computed tomography (CT) scan showed a 31 mm-sized pancreatic tail cancer with celiac artery and left adrenal gland abutment. The patient underwent neoadjuvant chemotherapy due to the risk of retroperitoneal cancer infiltration. After four cycles of FOLFIRINOX chemotherapy, follow-up CT scan showed the tumor decreased to 2.6 cm and celiac artery abutment became less prominent. Based on the CT scan, laparoscopic radical distal pancreatosplenectomy with left adrenalectomy was planned.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08670-9) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 7 April 2020 C. M. Kang, MD, PhD e-mail: [email protected]
Results. A five-port laparoscopic approach was performed, including three 12 mm trocars and an additional two 5 mm trocars. Initial intra-abdominal exploration showed no peritoneal seeding or micro liver metastasis. Gastric wedge resection was added due to cancer invasion for margin-negative resection. Operation time was 215 min and estimated blood loss was 200 cc without transfusion. The patient was discharged on postoperative day 6 without any complications, including postoperative pancreatic fistula. Conclusion. Laparoscopic distal pancreatosplenectomy can be technically feasible and safe to obtain negative resection margins in well-selected patients following neoadjuvant therapy in locally advanced pancreatic cancer.6
ACKNOWLEDGMENTS
None.
DISCLOSURES Seung Soo Hong, Ho Kyung Hwang, Woo Jung Lee, and Chang Moo Kang have no conflicts of interest to declare.
REFERENCES 1. McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2018;24(43):4846–61. 2. Hidalgo M. Pancreatic ca
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