Feasibility and Safety of Laparoscopic Radical Distal Pancreatosplenectomy with Adrenalectomy in Advanced Pancreatic Cancer

Introduction Pancreatic adenocarcinoma is a lethal condition with poor outcomes and an increasing incidence. 1 However, recent meta-analysis reported improved survival and R0 resection rate following neoadjuvant chemotherapy with subsequent surgery in initially unresectable pancreatic cancer. 2 In a...

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Bibliographic Details
Published in:Annals of surgical oncology 2020-12, Vol.27 (13), p.5235-5236
Main Authors: Hong, Seung Soo, Hwang, Ho Kyung, Lee, Woo Jung, Kang, Chang Moo
Format: Article
Language:English
Subjects:
Adenocarcinoma
Adenocarcinoma - surgery
Adrenal glands
Adrenalectomy
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Chemotherapy
Computed tomography
Diabetes mellitus
Feasibility Studies
Hepatobiliary Tumors
Humans
Laparoscopy
Male
Medical imaging
Medicine
Medicine & Public Health
Metastases
Middle Aged
Oncology
Pancreatectomy
Pancreatic cancer
Pancreatic Neoplasms - surgery
Peritoneal seeding
Peritoneum
Splenectomy
Surgery
Surgical Oncology
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Summary:Introduction Pancreatic adenocarcinoma is a lethal condition with poor outcomes and an increasing incidence. 1 However, recent meta-analysis reported improved survival and R0 resection rate following neoadjuvant chemotherapy with subsequent surgery in initially unresectable pancreatic cancer. 2 In addition, as a result of technological advances during the past 2 decades, even in pancreatic cancers, minimally invasive surgery (MIS) approaches are being used more frequently and safely. 3 – 5 This video shows the feasibility and safety of laparoscopic resection in advanced left-sided pancreatic cancer. Method The patient was a 63-year-old male with hypertension and diabetes. Initial computed tomography (CT) scan showed a 31 mm-sized pancreatic tail cancer with celiac artery and left adrenal gland abutment. The patient underwent neoadjuvant chemotherapy due to the risk of retroperitoneal cancer infiltration. After four cycles of FOLFIRINOX chemotherapy, follow-up CT scan showed the tumor decreased to 2.6 cm and celiac artery abutment became less prominent. Based on the CT scan, laparoscopic radical distal pancreatosplenectomy with left adrenalectomy was planned. Results A five-port laparoscopic approach was performed, including three 12 mm trocars and an additional two 5 mm trocars. Initial intra-abdominal exploration showed no peritoneal seeding or micro liver metastasis. Gastric wedge resection was added due to cancer invasion for margin-negative resection. Operation time was 215 min and estimated blood loss was 200 cc without transfusion. The patient was discharged on postoperative day 6 without any complications, including postoperative pancreatic fistula. Conclusion Laparoscopic distal pancreatosplenectomy can be technically feasible and safe to obtain negative resection margins in well-selected patients following neoadjuvant therapy in locally advanced pancreatic cancer. 6
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-020-08670-9