Ann Hepatobiliary Pancreat Surg.  2020 Nov;24(4):542-546. 10.14701/ahbps.2020.24.4.542.

Laparoscopic repeated pancreatectomy for isolated local recurrence in remnant pancreas following laparoscopic radical pancreatectomy for pancreatic ductal adenocarcinoma: Two cases report

• Choi M
• Lee SJ
• Shin DM
• Hwang HK
• Lee WJ
• Kang CM

• KMID: 2508867
• DOI: http://doi.org/10.14701/ahbps.2020.24.4.542

Abstract

Typical treatment for recurrent pancreatic cancer is potent chemotherapy or chemoradiotherapy. However, recent clinical investigations suggest a potential therapeutic role of local resection in recurrent pancreatic cancer. Based on accumulating surgical experience of minimally invasive pancreatectomy, we report cases of two patients who underwent successful laparoscopic re-resection of isolated local recurrence following laparoscopic radical pancreatectomy for pancreatic cancer.

Keyword

Laparoscopy; Pancreatic neoplasms; Pancreatectomy; Neoplasm recurrence; Local

Figure

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  Fig. 1 Perioperative findings. Recurrent pancreatic cancer was noted on remnant pancreas (A). The pancreatic neck was fully mobilized from the SMV-PV- SV confluence (B). Combined gastric wedge resection (thin white arrow) was performed (C). The splenic artery was dissected and resected by endo-GIA (yellow arrow), and the splenic vein was also ligated (thick arrow, D). T, tumor area in remnant pancreas; P, pancreatic neck; SMV, superior mesenteric vein; SV, splenic vein; S, stomach; CHA, common hepatic artery.

• 

  Fig. 2 Perioperative findings. Recurrent pancreatic cancer at the pancreaticojejunostomy (PJ) site (white arrow, A). The jejunum was resected near PJ site (B). Tumor was dissected from the superior mesenteric artery. The splenic artery was ligated with vascular endo GIA (yellow arrow, C). Gross findings of recurrent tumor at the PJ site (white arrow, D). CHA, common hepatic artery; SA, splenic artery; PJ, previous pancreaticojejunostomy site; J, proximal jejunum after resecting previous Roux-en-Y limb for PJ; SMA, superior mesenteric artery.

Reference

1. Groot VP, van Santvoort HC, Rombouts SJ, Hagendoorn J, Borel Rinkes IH, van Vulpen M, et al. 2017; Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT. HPB (Oxford). 19:83–92. DOI: 10.1016/j.hpb.2016.11.001. PMID: 28065427.

2. Ricci C, Casadei R, Taffurelli G, Toscano F, Pacilio CA, Bogoni S, et al. 2015; Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. J Gastrointest Surg. 19:770–781. DOI: 10.1007/s11605-014-2721-z. PMID: 25560180.

3. Lee SH, Kang CM, Hwang HK, Choi SH, Lee WJ, Chi HS. 2014; Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes. Surg Endosc. 28:2848–2855. DOI: 10.1007/s00464-014-3537-3. PMID: 24853839.

4. Peng L, Zhou Z, Cao Z, Wu W, Xiao W, Cao J. 2019; Long-term oncological outcomes in laparoscopic versus open pancreaticoduodenectomy for pancreatic cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 29:759–769. DOI: 10.1089/lap.2018.0683. PMID: 30835156.

5. Choi M, Hwang HK, Rho SY, Lee WJ, Kang CM. 2020; Comparing laparoscopic and open pancreaticoduodenectomy in patients with pancreatic head cancer: oncologic outcomes and inflammatory scores. J Hepatobiliary Pancreat Sci. 27:124–131. DOI: 10.1002/jhbp.697. PMID: 31705719.

6. Yamada S, Kobayashi A, Nakamori S, Baba H, Yamamoto M, Yamaue H, et al. 2018; Resection for recurrent pancreatic cancer in the remnant pancreas after pancreatectomy is clinically promising: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Surgery. 164:1049–1056. DOI: 10.1016/j.surg.2018.05.050. PMID: 30068484.

7. Hashimoto D, Chikamoto A, Masuda T, Nakagawa S, Imai K, Yamashita YI, et al. 2017; Pancreatic cancer arising from the remnant pancreas: is it a local recurrence or new primary lesion? Pancreas. 46:1083–1090. DOI: 10.1097/MPA.0000000000000897. PMID: 28902776.

8. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. 2011; FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 364:1817–1825. DOI: 10.1056/NEJMoa1011923. PMID: 21561347.

9. Lee K, Bang K, Yoo C, Hwang I, Jeong JH, Chang HM, et al. 2020; Clinical outcomes of second-line chemotherapy after progression on nab-paclitaxel plus gemcitabine in patients with metastatic pancreatic adenocarcinoma. Cancer Res Treat. 52:254–262. DOI: 10.4143/crt.2019.190. PMID: 31291709. PMCID: PMC6962478.

10. Zhou Y, Song A, Wu L, Si X, Li Y. 2016; Second pancreatectomy for recurrent pancreatic ductal adenocarcinoma in the remnant pancreas: a pooled analysis. Pancreatology. 16:1124–1128. DOI: 10.1016/j.pan.2016.09.015. PMID: 27717684.

11. Sunagawa H, Mayama Y, Orokawa T, Oshiro N. 2014; Laparoscopic total remnant pancreatectomy after laparoscopic pancreaticoduodenectomy. Asian J Endosc Surg. 7:71–74. DOI: 10.1111/ases.12064. PMID: 24450349.

12. Nakagawa Y, Fukami Y, Harada T, Maeda A, Takayama Y, Takahashi T, et al. 2020; Laparoscopic pancreaticoduodenectomy for remnant pancreatic recurrence after laparoscopic distal pancreatectomy and hepatectomy for greater omentum leiomyosarcoma. Asian J Endosc Surg. 13:117–120. DOI: 10.1111/ases.12695. PMID: 30843350.