Laparoscopic Parenchymal Sparing Multiple Metastatectomy Combined with Left Lateral Segmentectomy for Long Term Hepatic Recurrence from Resected Solid Pseudopapillary Tumor of Pancreas

Abstract

Introduction: Solid pseudopapillary neoplasm(SPN) of the pancreas are rare tumors that occurs in young women. SPN can metastasizes in 5–15% of all cases and the common site is the liver. The management of metastatic tumors of SPN is unclear. We report a case of Laparoscopic Parenchymal Sparing Multiple Metastatectomy Combined with Left Lateral Segmentectomy for long term Hepatic Recurrence from Resected Solid Pseudopapillary tumor of Pancreas. Case/methods: A 26-year-old lady underwent distal pancreatectomy with splenectomy on 30/3/2015 for solid pseudopapillary tumor of pancreas. Patient was on routine follow up and a PET CT done on 14/10/2020 showed Multiple Bilobar Liver Metastasis in Segments 2/3, 6, 7, 8. Patient underwent of Laparoscopic Parenchymal Sparing Multiple Metastatectomy Combined with Left Lateral Segmentectomy on 22/10/2020. Intra operatively, metastasis was noted at segment 6,7,8 sub capsular. Intraoperative USG showed deep seated segment 2 metastasis for which Laparoscopic left lateral Segmentectomy was done. Results: Postoperative period was uneventful. Histopathology confirmed the 4 metastasis with adequate margins. She was discharged on post-operative day 2. Post 10 months of surgery patient is having a disease-free survival. Conclusion: Long term hepatic recurrence in SPN is rare. Aggressive management of Liver Metastasis ensures a long term disease free survival. In our case we were able to manage the multiple liver metastasis using a combination of Laparoscopic Parenchymal sparing hepatic metastatectomy and Left Lateral Segmentectomy to achieve a R0 resection and this reinforces the role of laparoscopic liver surgery even in such rare tumors.