Ann Hepatobiliary Pancreat Surg.  2020 Feb;24(1):90-96. 10.14701/ahbps.2020.24.1.90.

Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging?

Affiliations
  • 1Department of General and Pancreatic Surgery, University of Verona, The Pancreas Institute, Verona Hospital Trust, Verona, Italy.
  • 2Department of HPB Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain. rlopezandujar@telefonica.net
  • 3Department of Pathology, Hospital Universitario La Fe, Valencia, Spain.

Abstract

Indications and outcomes of extended pancreatectomies have been recently appraised by the International Study Group for Pancreatic Surgery. However, no definitive conclusions have been drawn, particularly in the setting of neoadjuvant treatments. We present here a case of 53-year-old man diagnosed with a bulky adenocarcinoma of the tail of the pancreas and infiltrating the adjacent organs and the thoracic wall. The patient was sent to neoadjuvant chemotherapy and he underwent 12 cycles of FOLFIRINOX. Since a significant radiological response was observed after chemotherapy, the patient was scheduled for extended distal pancreatectomy with en bloc resection of the thoracic wall, in order to achieve a radical resection. The surgery is herein described with all technical details. The patient was discharged after an uneventful early post-operative course and subsequently readmitted for a late grade B post-operative pancreatic fistula, which was ultimately treated successfully. Pathology showed complete response. When performed in centers with ample experience in pancreatic surgery, extended pancreatic resections represent a viable curative option with acceptable surgical outcomes. In this setting, challenging tailored resections should be considered to achieve negative margins, particularly following maximized effective downstaging strategies.

Keyword

Pancreatic surgery; FOLFIRINOX; Extended pancreatectomy; Multivisceral resection

MeSH Terms

Adenocarcinoma
Drug Therapy
Humans
Middle Aged
Neoadjuvant Therapy
Pancreas
Pancreatectomy*
Pancreatic Fistula
Pancreatic Neoplasms*
Pathology
Tail
Thoracic Wall*
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