Total pancreatectomy for multifocal pancreatic cancers

Abstract

Presenter: Hiromichi Ito | Cancer Institute Hospital, Japanese Foundation for Cancer Research Background: It is not uncommon that intraductal neoplasm of the pancreas including intraductal papillary mucinous neoplasm (IPMN) and intraductal tubulopapillary neoplasm (ITPN) involves the entire pancreas, and total pancreatectomy is necessary for patients with such tumors to achieve cure.Herein, we illustrate the case of the patient with multifocal pancreatic cancers who underwent total pancreatectomy. The disease turned out to be derived from IPMN by histologic examination in the resected specimen. Methods: The patient was an 82-year-old woman who presented with epigastric pain and CT showed large pancreatic body mass. The staging work-up revealed at least 5 PET-avid lesions throughout the entire pancreas without extra-pancreatic metastasis, and EUS-FNA confirmed them as adenocarcinoma. Thus, total pancreatectomy was recommended. Results: Upon the exploration, there was no evidence of metastatic disease, and IOUS confirmed all pancreatic lesions identified by preoperative scans. Total pancreatectomy was completed uneventfully in 560 minutes with blood loss of 430 cc. Her postoperative course was uncomplicated. The pathology showed multifocal pancreatic cancers derived from IPMN. ITPN was ruled out by presence of MUC5AC expression on immunohistochemistry. Conclusion: The video described the technical detail of our total pancreatectomy and some useful tricks including SMA-first approach and left kidney mobilization to minimize blood loss and to maintain good exposure for dissection plane in the left side.