Distal pancreatectomy with celiac axis resection for locally advanced pancreatic carcinoma: case report

ABSTRACT

Long-term survival of pancreatic ductal adenocarcinoma after surgery is still rare. One of the main reasons for unresectability is the tumor invasion of the main vessels, such as the celiac axis, common hepatic artery and superior mesenteric artery. The optimal management of these patients is controversial. Despite the challenges on the topic, we present a case of pancreatic ductal adenocarcinoma with invasion of the celiac axis treated with pancreatectomy and vascular resection plus perioperative chemoradiotherapy. After 30 months of follow-up, hepatic and peritoneal recurrence were identified. Palliative chemotherapy was administered until disease progression and death in March 2020. Surgical resection when used in selected patients, proved to be feasible with acceptable morbidity. Besides that, the aggressive surgical approach associated with multimodal schemes provided an improvement in disease-free and overall survival.

RESUMO

A sobrevida a longo prazo do adenocarcinoma ductal pancreático após a cirurgia ainda é rara. Um dos principais motivos da irressecabilidade é a invasão tumoral dos principais vasos, como o eixo celíaco, a artéria hepática comum e a artéria mesentérica superior. O manejo ideal desses pacientes é controverso. Apesar dos desafios no assunto, apresentamos um caso de adenocarcinoma ductal pancreático com invasão do eixo celíaco tratado com pancreatectomia e ressecção vascular associada à quimiorradioterapia perioperatória. Após 30 meses de acompanhamento, foram identificadas recidivas hepática e peritoneal. A quimioterapia paliativa foi administrada até a progressão da doença e óbito em março de 2020. A ressecção cirúrgica, quando utilizada em pacientes selecionados, mostrou-se viável com morbidade aceitável. Além disso, a abordagem cirúrgica agressiva associada a esquemas multimodais proporcionou melhora na sobrevida livre de doença e global.

Keywords:

Neoadjuvant therapy - Pancreatic neoplasms - Surgery.

Descritores:

Terapia neoadjuvante - Neoplasias pancreáticas - Cirurgia.

Publikationsverlauf

Eingereicht: 29. Juli 2020

Angenommen: 17. Juni 2021

Artikel online veröffentlicht:
14. Juli 2021

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