Feasibility and Safety of Laparoscopic Radical Distal Pancreatosplenectomy with Adrenalectomy in Advanced Pancreatic Cancer

Abstract

Introduction: Pancreatic adenocarcinoma is a lethal condition with poor outcomes and an increasing incidence.1 However, recent meta-analysis reported improved survival and R0 resection rate following neoadjuvant chemotherapy with subsequent surgery in initially unresectable pancreatic cancer.2 In addition, as a result of technological advances during the past 2 decades, even in pancreatic cancers, minimally invasive surgery (MIS) approaches are being used more frequently and safely.3-5 This video shows the feasibility and safety of laparoscopic resection in advanced left-sided pancreatic cancer.

Method: The patient was a 63-year-old male with hypertension and diabetes. Initial computed tomography (CT) scan showed a 31 mm-sized pancreatic tail cancer with celiac artery and left adrenal gland abutment. The patient underwent neoadjuvant chemotherapy due to the risk of retroperitoneal cancer infiltration. After four cycles of FOLFIRINOX chemotherapy, follow-up CT scan showed the tumor decreased to 2.6 cm and celiac artery abutment became less prominent. Based on the CT scan, laparoscopic radical distal pancreatosplenectomy with left adrenalectomy was planned.

Results: A five-port laparoscopic approach was performed, including three 12 mm trocars and an additional two 5 mm trocars. Initial intra-abdominal exploration showed no peritoneal seeding or micro liver metastasis. Gastric wedge resection was added due to cancer invasion for margin-negative resection. Operation time was 215 min and estimated blood loss was 200 cc without transfusion. The patient was discharged on postoperative day 6 without any complications, including postoperative pancreatic fistula.

Conclusion: Laparoscopic distal pancreatosplenectomy can be technically feasible and safe to obtain negative resection margins in well-selected patients following neoadjuvant therapy in locally advanced pancreatic cancer.6.