Chaya Shwaartz, MD1, Mor Aharoni, MD1, Joe Kim, MD2, Motti Cordova, MS1, Yuri Goldes, MD1. 1Sheba Medical Center, 2Summit Medical Grouup
This is a case of a 45 years old female with no significant past medical history who was diagnosed with non functional PNET at the neck of the pancreas. On imaging the mass was the size of 2.5 cm, involving the main pancreatic duct. The pt was presented in a multidisciplinary meeting and the decision was made to continue to surgery.
After general inspection of the peritoneal cavity, the lesser sac was entered by dividing the gastrocolic omentum (from distal antrum up to the fundus of stomach including the short gastric vessels, so as to expose the tail of pancreas). Adhesions between the posterior wall of stomach and pancreas are released completely. Dissection of the inferior border of the pancreas and mobilisation of its posterior surface are performed by retracting the transverse colon downwards and dividing the anterior layer of the transverse mesocolon.
Dissection is continued until the splenic vein is identified. The junction of the splenic vein and the superior mesenteric vein is identified. The pancreas along with the tumour-containing segment is dissected from the splenic vein, so as to have a 1 cm margin distally and proximally. Mobilisation of the body of the pancreas is done beyond the portal vein. Batressed Endo GIA stapler is used to divide the pancreas proximal to the tumour.
Distal pancreatic stump is anastomosed to the stomach intracorporeally. Postoperatively the patient was doing well. Pathology report showed 2.5 cm PNET well differentiated G1 tumor with Ki67 2% with no lymphovascular invasion or perineural invasion. Clean margins and no lymph node metastasis.
To conclude laparoscopic central pancreatectomy is a feasible and safe procedure. This surgery saves pancreatic tissue and preserving the spleen. However, pt selection and disease selection are crucial.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95048
Program Number: V320
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop