Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm-associated pancreatic cancer: A case report.

Hiroki Kaida,Yousuke Hirano,Masato Watanabe,Marina Morishita,Ryosuke Shibata,Shugo Uwatoko,Satoshi Nimura,Nobuhiko Koreeda,Akira Komono,Yoshihiro Miyasaka,Ryohei Sakamoto,Toshihiro Ohmiya,Daijiro Higashi,Makoto Kawamoto

doi:10.1016/j.ijscr.2021.106376

Hiroki Kaida, Yousuke Hirano + Show 12 more

Open Access

https://doi.org/10.1016/j.ijscr.2021.106376

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Abstract

Introduction and importanceIntraductal papillary mucinous neoplasm (IPMN) of the pancreas is often found incidentally during examination for other diseases. In addition to the risk of malignant transformation, patients with IPMN are at risk of developing pancreatic cancer. We report a case of pancreatic tail cancer that developed separately from a preexisting IPMN after minimally invasive esophagectomy for cancer of the esophagogastric junction and was resected successfully by laparoscopic distal pancreatectomy.Case presentationA 72-year-old man underwent thoracoscopic and laparoscopic esophagectomy for esophagogastric junction cancer. He had undergone surgery for ascending colon cancer 20 years ago. At that time, IPMN was confirmed in the pancreatic body by a preoperative examination. Computed tomography was regularly performed for postoperative work-up and follow-up of the IPMN, and a solid lesion with cystic components was detected in the pancreatic tail 9 months after the operation. On detailed examination, pancreatic ductal adenocarcinoma concomitant with IPMN, accompanied by a retention cyst, was considered. Laparoscopic distal pancreatectomy was successfully performed after neoadjuvant chemotherapy. Pathological diagnosis of the lesion in the pancreatic tail was of an invasive intraductal papillary mucinous carcinoma (ypT3ypN0yM0 ypStageIIA).Clinical discussionIf an IPMN is detected during preoperative examination for malignancies of other organs, careful follow-up is necessary due to the high risk of pancreatic cancer development. Furthermore, initial operation with minimally invasive surgery may reduce adhesion and facilitate subsequent surgeries.ConclusionWe have provided evidence that supports the importance of a careful follow-up of IPMNs, even if they are low risk.

Highlights

Introduction and importanceIntraductal papillary mucinous neoplasm (IPMN) of the pancreas is often found incidentally during examination for other diseases
We report a case of pancreatic tail cancer that developed separately from a preexisting IPMN after minimally invasive esophagectomy for cancer of the esophagogastric junction; the cancer was resected successfully by laparoscopic distal pancreatectomy
During follow-up of an IPMN in the pancreatic body identified during preoperative examination for a minimally invasive esophagectomy for esophagogastric junction cancer, a solid lesion with a cystic component in the pancreatic tail was recognized 9 months later

Summary

Introduction

Intraductal papillary mucinous neoplasm (IPMN) is often recognized incidentally during examination of organs, other than the pancreas, for malignancy. Follow-up is recommended even for IPMNs with a low risk of malignancy, because malignant transformation may occur over time. The incidence of pancreatic cancer (over a 5-year period) in patients with IPMN is reported to be 2.5%–2.8% [1,2,3,4,5,6,7]. IPMN is considered a risk factor for pancreatic cancer. We report a case of pancreatic tail cancer that developed separately from a preexisting IPMN after minimally invasive esophagectomy for cancer of the esophagogastric junction; the cancer was resected successfully by laparoscopic distal pancreatectomy

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