Laparoscopic omentopexy as a spacer for carbon-ion radiotherapy in locally advanced pancreatic cancer

Abstract

Although half of the patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed at an advanced stage, surgical interventions needed at this stage are currently limited. Carbon-ion radiotherapy (CIRT) has emerged as a promising treatment modality for PDAC owing to its superior physical and radiobiological properties. However, a major challenge in this treatment is the proximity of the pancreas to radiosensitive organs including the stomach and duodenum, which limits dose escalation and increases the risk of severe complications, including ulceration and perforation. Herein, we report our experience with laparoscopic omentopexy as a spacer technique before CIRT in patients with locally advanced PDAC. A 55-year-old female with locally advanced PDAC, secondary to unreconstructible superior mesenteric vein involvement, who had planned to undergo CIRT. After 28 cycles of modified FOLFIRINOX, the tumor size demonstrated slight shrinkage. However, the tumor abutted the posterior wall of the stomach, raising concerns about ensuring a sufficient safety margin while delivering a curative dose of CIRT. Therefore, laparoscopic omentopexy was performed for spacer implantation between the pancreas and stomach. The patient was discharged on the postoperative day 2 without any complications. One month after the omentopexy, the patient completed all 12 fractions of the CIRT with no acute complications, except for grade 1 fatigue. After completing CIRT, the patient underwent regular follow-up evaluations. Laparoscopic omentopexy before CIRT in patients with locally advanced PDAC could enhance therapeutic efficacy.