Visceral debranching followed by chemotherapy and resection for locally advanced pancreatic cancer with arterial invasion: case report

Abstract

The oncological outcome of patients with locally advanced pancreatic cancer continues to be dismal. Abutment or invasion of visceral arteries, which constitutes irresectability according to the consensus of the International Association of Pancreatology and can be found in a considerable proportion of patients upon initial diagnosis, usually precludes complete resection in curative intent. Simultaneous tumor resection and arterial reconstruction are associated with relevant morbidity and mortality. Here, we present a case in which a therapeutic split was done so that isolated arterial reconstruction (visceral debranching with an iliacohepatic bypass graft) preceded neoadjuvant FOLFIRINOX chemotherapy and subsequent multivisceral tumor resection. Despite several perioperative vascular complications, which were addressed by surgical and endovascular techniques, the patient had a favorable outcome of the operations and is tumor-free after 8 months of follow-up. The feasibility and safety of this novel therapeutic strategy of a therapeutic split with isolated visceral debranching as the first treatment step is currently evaluated in a clinical trial (PREVADER, NCT04136769).