Yoo-Seok Yoon, MD, PhD, Ho-Seong Han, MD, PhD, Jae Young Cho, MD, PhD, YoungRok Choi, Jangkyu Choi, Seong Uk Kwon, Jae Sung Jang, Sungho Kim. Seoul National University Bundang Hospital
Background: Numerous recent studies have reported comparable oncologic outcomes of laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) compared with open surgery. Most of these laparoscopic procedures, however, involved resection for PDAC in the body and tail of the pancreas where R0 resection was possible by pancreatic transection around the portal vein–superior mesenteric vein with preservation of the gastroduodenal artery (GDA). Here we describe our technique of laparoscopic radical subtotal pancreatectomy for PDAC located in the neck of the pancreas, which requires resection of the GDA to achieve a clear resection margin.
Methods: A pancreatic mass was detected in a 72-year-old female at a routine health check. Abdominal CT revealed a low-attenuating mass of diameter 2 cm located in the neck of the pancreas, close to the GDA. Laparoscopic subtotal pancreatectomy with resection of the GDA was planned, with the goal of obtaining clear margins.
Results: Surgery was performed using a five-trocar technique. Subtotal pancreatectomy near the duodenum was performed after resection of the GDA. The pancreas was transected using ultrasonic shears and the exposed main pancreatic duct was repaired with suture ligation. Lymph nodes on the left side of the celiac axis and superior mesenteric artery were dissected. Retroperitoneal dissection was performed by anterior radical antegrade modular pancreatosplenectomy, exposing the left renal vein and saving the left adrenal gland. The operative time was 220 minutes and the estimated intraoperative blood loss was 200 mL. The postoperative pathology confirmed a PDAC with a 5 mm tumor-free pancreatic resection margin. The pathologic staging was pT3N0, and 21 lymph nodes were retrieved. The patient was discharged on postoperative day 7 with no postoperative complications.
Conclusion: Curative resection of PDAC located in the neck of the pancreas can be safely performed by laparoscopic subtotal pancreatectomy with resection of the GDA.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78774
Program Number: V089
Presentation Session: Friday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo
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