Robot-assisted combined pancreatectomy/hepatectomy for metastatic pancreatic acinar cell carcinoma: case report and revi
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CASE REPORT
Robot‑assisted combined pancreatectomy/hepatectomy for metastatic pancreatic acinar cell carcinoma: case report and review of the literature Anthony Michael Villano1 · Dany Barrak1 · Anish Jain2 · Erin Meslar3 · Pejman Radkani3 · Walid Chalhoub4 · Nadim Haddad4 · Emily Winslow3 · Thomas Fishbein3 · Jason Hawksworth3 Received: 30 March 2020 / Accepted: 1 June 2020 © Japanese Society of Gastroenterology 2020
Abstract Acinar cell carcinoma (ACC) of the pancreas is a rare neoplasm with less aggressive behavior than ductal carcinoma. As a result, surgical resection for metastatic ACC is a therapeutic option which can result in long-term survival. There is a paucity of data describing institutional approaches to these challenging patients, and therefore, we herein describe our institution’s approach to a patient with a distal pancreatic ACC and isolated liver metastasis. The patient underwent neoadjuvant chemotherapy (FOLFIRINOX), followed by a robot-assisted distal pancreatectomy/splenectomy and non-anatomic segment 6 resection. He was discharged to home post-operative day 2. Final pathology revealed complete tumor response of the liver metastasis and a margin negative resection of the primary tumor. He remains disease free and without complications at 3 months. We highlight that combined modality therapy for metastatic ACC can yield long-term survival in selected patients. Similarly, the robotic platform enables performance of complex multivisceral resections with rapid recovery. Future research investigating precision medicine for metastatic ACC is warranted given widely variable tumor biology in this disease. Keywords Pancreas · Cancer · Acinar cell · Robotic · Surgery · Metastatic · Multivisceral · Carcinoma
Introduction Pancreatic acinar cell carcinoma (ACC) is an exceedingly rare neoplasm comprising less than 2% of all pancreas tumors. ACCs exhibit a slight preponderance for the head Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12328-020-01146-z) contains supplementary material, which is available to authorized users. * Jason Hawksworth [email protected] 1
Department of General Surgery, MedStar-Georgetown University Hospital, Washington, DC, USA
2
Howard University School of Medicine, Washington, DC, USA
3
MedStar Georgetown Transplant Institute, MedStar-Georgetown University Hospital, 3800 Reservoir Rd., NW, PHC Building, 2nd Floor, Washington, DC 20007, USA
4
Department of Gastroenterology, MedStar-Georgetown University Hospital, Washington, DC, USA
of the pancreas, occur more commonly in males, and tend to present at comparatively large size (mean diameter 6–8 cm) with other pancreatic tumors [1, 2]. Nearly 50% of patients will present with metastatic disease, and an additional 25% will develop systemic disease at a later point in the course of their disease [1]. Despite this behavior, ACCs are still biologically more favorable than pancreatic ductal cell adenocarcinomas (PDACs) and a better survival h
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