Yonsei Med J.  2014 Jan;55(1):276-279. 10.3349/ymj.2014.55.1.276.

A Five-Year Survivor without Recurrence Following Robotic Anterior Radical Antegrade Modular Pancreatosplenectomy for a Well-Selected Left-Sided Pancreatic Cancer

• Han DH
• Kang CM
• Lee WJ
• Chi HS

• KMID: 1779918
• DOI: http://doi.org/10.3349/ymj.2014.55.1.276

Abstract

Radical antegrade modular pancreatosplenectomy (RAMPS) is regarded as a reasonable approach for margin-negative and systemic lymph node clearance in left-sided pancreatic cancer. We present a patient with more than 5 years disease-free survival after robotic anterior RAMPS for pancreatic ductal adenocarcinoma in the body of the pancreas. The distal part of pancreas, soft tissue around the celiac trunk, and the origin of splenic vessels was dissected with the underlying fascia between the pancreas and adrenal gland. Resected specimen was removed through small vertical abdominal incision. Robot working time was about 8 hours, and blood loss was about 700 mL without blood transfusion. He returned to an oral diet on the postoperative first day and recovered without any clinically relevant complications. There was no lymph node metastasis, perineural or lymphovascular invasion. Both the pancreatic resection margin and the tangential posterior margin were free of carcinoma. The patient received only postoperative adjuvant radiotherapy around the tumor bed. The patient has survived for more than 5 years without evidence of cancer recurrence. Minimally invasive radical left-sided pancreatectomy with splenectomy may be oncologically feasible in well-selected pancreatic cancer.

Keyword

Robotic surgery; pancreatosplenectomy; pancreatic cancer

MeSH Terms

Aged
Disease-Free Survival
Humans
Male
Pancreatectomy
Pancreatic Neoplasms/*surgery
Splenectomy

Figure

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  Fig. 1 Perioperative surgical outcomes. Low attenuated pancreatic tumor located to the pancreatic body (A) with obstructive distal pancreatic duct dilatation (B) was noted on pre-operative radiologic images. The mass was confined to the pancreatic body with intact fascia layer between the pancreas and left adrenal gland. In addition, tumor was apart from celiac axis more than 2 cm. Therefore, it was possible to be removed safely by modified anterior RAMPS [note the dissection plane, white dotted line, (A)]. Robot-assisted anterior RAMPS was performed, and pathology examination revealed that the tumor was a pancreatic ductal adenocarcinoma with pT3N0M0, stage IIA (C and D). Postoperative adjuvant radiotherapy was given (E). Postoperative CA 19-9 declined and remained within the normal range (F). *Soft tissue around celiac axis. pP, proximal pancreas; dP, distal pancreas; SAO, the origin of the splenic artery; SV, the junction of splenic vein to superior mesenteric vein; RAMPS, radical antegrade modular pancreatosplenectomy.

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