Abstract
Introduction: Recent years have witnessed efforts to push boundaries of resectional procedures in an attempt to achieve cure in pancreatic cancer. These include combined venous and arterial resections and multivisceral resections. Here we share our experience with such an unusual procedure, in which both multivisceral resection and combined vascular resections were performed. Method: This was a 79 year-old lady diagnosed with cancer of the body of the pancreas. She had received six cycles of FOLFIRINOX neoadjuvant chemotherapy for downsizing of the tumor, which had partly invaded SMA at the beginning of treatment. CT scan obtained before surgery showed complete tumoral involvement of the SMV-splenic vein confluence, celiac axis, common hepatic artery, left gastric artery and splenic artery as well as 70 degree contact with SMA. Results: Following exploration to rule out peritoneal disease, hepatic artery, GDA, portal vein and common bile duct were exposed. Dissection was continued to expose SMV and distal SMA. Since right gastroepiploic, left gastric, splenic and middle colic arteries and corresponding veins were invaded by the tumor, duodenum, stomach, left colon and spleen were skeletonized for enbloc resection with pancreas. Following harvesting of the left saphenous vein, specimen was removed after portal vein and celiac axis resection. Portal venovenous anastomosis and saphenous vein interposition for hepatic arterial flow was done. The procedure was finalized with re-establishment of gastrointestinal continuity. The patient was discharged home on POD#22. Conclusions: Complex multivisceral and vascular resections can offer cure for patients with locally advanced pancreatic cancer who otherwise deemed unresectable.
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