Ann Hepatobiliary Pancreat Surg.  2020 Nov;24(4):551-556. 10.14701/ahbps.2020.24.4.551.

Neoadjuvant chemotherapy followed by total pancreatectomy with splenectomy and combined vascular resections after preoperative percutaneous transhepatic portal vein stent placement in locally advanced pancreatic cancer with portal vein total obliteration

• Kook Y
• Choi M
• Park JY
• Chung YE
• Man-Deuk MD
• Lee WJ
• Kang CM

• KMID: 2508869
• DOI: http://doi.org/10.14701/ahbps.2020.24.4.551

Abstract

Pancreatic cancer is one of the most lethal malignant diseases in gastrointestinal system that only about 15-20% of the patients are potential candidates for resection at diagnostic stage. However, with the advent of neoadjuvant chemotherapy and advancement of surgical skills, patients with locally advanced pancreatic cancer (LAPC), which were deemed initially unresectable, have undergone margin negative radical resection. Here, we present a case of a patient with LAPC who was previously treated with neoadjuvant FOLFIRINOX and underwent pancreaticoduodenectomy combined with vascular resection after preoperative percutaneous transhepatic portal vein stent placement to relieve of portal vein obliteration. The patient recovered without any complication and was discharged on day 8 postoperatively.

Keyword

Locally advanced pancreatic cancer; Neoadjuvant chemotherapy; Portal vein stent

Figure

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  Fig. 1 Preoperative image study and PTPVS insertions. Endoscopic biliary drainage tube and periportal cavernous transformation (thin white arrows) due to total obliteration of portal vein by the tumor (*) are noted (A and C). Common hepatic artery and gastroduodenal artery invasion is highly suspected (thick black arrow, B). Preoperative PTPVS was inserted. Note that periportal collateral vessels (thin white arrows, D) all disappeared immediately after successful PTPVS (E). Preoperative 3-dimensional arterial reconstruction can be helpful when designing the surgical strategy. Portal vein stent can be identified with endoscopic biliary drainage tube.

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  Fig. 2 Operative view and surgical specimens. Grossly margin-negative resection was performed. Note the arterial (long thin white arrow) and portal vein (short thin white arrow) reconstruction (A). Surgical specimen is excised en-bloc (B). Note the combined resection of common hepatic artery-gastroduodenal artery-proper hepatic artery confluence (red colored vessel-loop, C) and segment of PV with PTPVS (blue colored vessel-loop, D).

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  Fig. 3 Postoperative changes of liver function test.

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