Ann Hepatobiliary Pancreat Surg.  2022 Feb;26(1):118-123. 10.14701/ahbps.21-097.

Laparoscopic radical distal pancreatosplenectomy with celiac axis excision following neoadjuvant chemotherapy for locally advanced pancreatic cancer

• Kim YS
• Kim JS
• Kim SH
• Hwang HK
• Lee WJ
• Kang CM

• KMID: 2526841
• DOI: http://doi.org/10.14701/ahbps.21-097

Abstract

A recent successful prospective randomized control study comparing open distal pancreatectomy with laparoscopic distal pancreatectomy (LDP) has shown that LDP is a safe and effective surgical modality in treating left-sided pancreatic pathological conditions requiring surgical extirpation. With the accumulating surgical experiences and improved surgical techniques, we recently reported several cases of successful LDP in advanced pancreatic cancer following neoadjuvant chemotherapy. Herein, we report a case of LDP with celiac axis resection (LDP-CAR) in locally advanced pancreatic cancer (LAPC) following neoadjuvant chemotherapy. A 58-yearold female with LAPC was referred to our institution. Computed tomography (CT) findings revealed a 24-mm mass in the pancreatic body that showed celiac artery (CA), common hepatic artery abutment. There was no abutment with superior mesenteric artery, superior mesenteric vein, and portal vein. From these findings, Neoadjuvant chemotherapy (FORFIRINOX) was performed biweekly. After 8 cycles of chemotherapy, the tumor size was slightly decreased (24 mm to 16 mm), but still abutting to CA. After 14 cycles of chemotherapy, CT revealed the same tumor size (16 mm) still abutting to CA. LDP-CAR was performed. Intraoperative ultrasonography gastric perfusion and hepatic perfusion were confirmed using indocyanine green. The patient recovered without complications and was discharged from the hospital nine days after the surgery.

Keyword

Pancreatectomy; Neoadjuvant therapy; Laparoscopic surgery

Figure

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  Fig. 1 Preoperative image. (A) Initial computed tomography (CT) scan. The tumor was abutting to the bifurcation site of CA and CHA (coronal view). (B) Preoperative CT scan. The tumor was still abutting to CA (coronal view). (C) Initial CT scan. The tumor was abutting to the bifurcation site of CA and CHA (axial view). (D) Preoperative CT scan. The tumor was still abutting to CA (axial view). CA, celiac axis; CHA, common hepatic artery; SA, splenic artery; T, tumor.

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  Fig. 2 Intraoperative finding. (A) Liver perfusion can be clearly evaluated after clamping common hepatic artery (CHA) (white short arrow), LGA (white arrowhead), and small collateral artery (white tall arrow). (B) Division of CHA (thick white arrows). Double asterisk indicates celiac artery (CA). (C) Division of CA. (D) Division of LGA, thick white arrows indicate resected CA. Thin white arrows indicate resected CHA. G, stomach; P, pancreas; SMA, superior mesenteric artery; LGA, left gastric artery.

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  Fig. 3 Postoperative intraoperative ultrasonography (IOUS) and indocyanine green (ICG) gastric perfusion. (A) Postoperative view. The small multiple white arrows indicate resected celiac axis (CA). Black arrow means resected splenic vein. The large white arrow shows resected common hepatic artery (CHA). (B) ICG showed good perfusion of the remaining stomach. (C) IOUS demonstrated well-preserved intrahepatic pulsation (white arrows). (D) Surgical Specimen, white arrowheads indicate resection margin of the pancreas. Note the orifice resected CHA (black arrow), CA (thick white arrow), and left gastric artery (thin tall white arrow). P, pancreas; G, stomach; SMA, superior mesenteric artery; Adr, adrenal gland; LRV, left renal vein; L, liver,

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