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DOI: 10.5935/2526-8732.20210017
Distal pancreatectomy with celiac axis resection for locally advanced pancreatic carcinoma: case report
Pancreatectomia distal com ressecção do eixo celíaco para carcinoma pancreático localmente avançado: relato de caso
Financial support: none to declare.
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.
Publication History
Received: 29 July 2020
Accepted: 17 June 2021
Article published online:
14 July 2021
© 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Renato Morato Zanatto, Patrícia Medeiros Milhomem Beato, Maurício José Vieira, Celso Roberto Passeri. Distal pancreatectomy with celiac axis resection for locally advanced pancreatic carcinoma: case report. Brazilian Journal of Oncology 2021; 17: e-20210017.
DOI: 10.5935/2526-8732.20210017
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REFERENCES
- Siegel RL, Miller KD, Jemal A.. Cancer statistics, 2020. CA Cancer J Clin 2020; Jan; 70 (01) 7-30 https://doi.org/10.3322/caac.21590
- Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS.. National failure to operate on early stage pancreatic cancer. Ann Surg 2007; Aug; 246 (02) 173-180 https://doi.org/10.1097/SLA.0b013e3180691579
- Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA.. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg 2012; Aug; 99 (08) 1027-1035 https://doi.org/10.1002/bjs.8763
- Tseng JF, Raut CP, Lee JE, Pisters PWT, Vauthey JN, Abdalla EK. et al Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004; Dec; 8 (08) 935-950 https://doi.org/10.1016/j.gassur.2004.09.046
- Gurusamy KS, Kumar S, Davidson BR, Fusai G.. Resection versus other treatments for locally advanced pancreatic cancer. Cochrane Database Syst Rev 2014; Feb; (02) CD010244
- Yamada S, Fujii T, Sugimoto H, Shuji N, Shin T, Yasuhiro K. et al Aggressive surgery for borderline resectable pancreatic cancer: evaluation of National Comprehensive Cancer Network guidelines. Pancreas 2013; Aug; 42 (06) 1004-1010 https://doi.org/10.1097/MPA.0b013e31827b2d7c
- Sohal D, Duong MT, Ahmad SA, Gandhi N, Beg MS, Wang-Gillam A. et al SWOG S1505: results of perioperative chemotherapy (peri-op CTx) with mfolfirinox versus gemcitabine/nab-paclitaxel (Gem/nabP) for resectable pancreatic ductal adenocarcinoma (PDA). J Clin Oncol 2020; 38 (Suppl 15): 4504
- Hidalgo M.. Pancreatic cancer pancreatic cancer: overview. N Engl J Med 2011; Aug; 362: 1605-1617
- Spitz FR, Abbruzzese JL, Lee JE, Pisters PW, Lowy AM, Fenoglio CJ. et al Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997; 15 (03) 928-937 https://doi.org/10.1200/JCO.1997.15.3.928
- Hackert T, Sashsenmaier M, Hinz U, Schneider L, Michalski CW, Springfeld C. et al Locally advanced pancreatic cancer: neoadjuvant therapy with folfirinox results in resectability in 60% of the patients. Ann Surg 2016; Sep; 264 (03) 457-461
- Kelemen D, Locsei Z, Papp R, Ferencz S, Vereczkei A.. Appleby procedure - an option for surgical treatment of pancreatic body tumour infiltrating the celiac axis. Magy Seb 2018; Mar; 71 (01) 16-20 https://doi.org/10.1556/1046.71.2018.1.3
- Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A. et al Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical practice guideline. J Clin Oncol 2016; Jul; 34 (21) 2541-2556
- Kensuke Y, Yamashita YI, Yamao T, Kuroda D, Eto T, Kitano Y. et al Efficacy of staging laparoscopy for pancreatic cancer. Anticancer Res 2020; Feb; 40 (02) 1023-1027 https://doi.org/10.21873/anticanres.14037
- Takadate T, Morikawa T, Ishida M, Aoki S, Hata T, Iseki M. et al Staging laparoscopy is mandatory for the treatment of pancreatic cancer to avoid missing radiologically negative metastases. Surg Today 2020; Sep; 51 (01) 686-694 https://doi.org/10.1007/s00595-020-02121-4
- Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C. et al Cancer statistics, 2006. CA Cancer J Clin 2006; Mar/Apr; 56 (02) 106-130
- American Cancer Society (ACS). Cancer facts and Statistics - Figures 2013 [Internet]. Atlanta: ACS;; 2013. access in ANO Mês dia Available from: www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2013
- Malvezzi M, Bertuccio P, Levi F, Vechia CL, Negri E.. European cancer mortality predictions for the year 2013. Ann Oncol 2013; Mar; 24 (03) 792-800
- Hawes RH, Xiong Q, Waxman I, Chang KJ, Evans DB, Abbruzzesse JL. A multispecialty approach to the diagnosis and management of pancreatic cancer. Am J Gastroenterol 2000; Jan; 95 (01) 17-31
- Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y. et al FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; May; 364: 1817-1825
- Raut V, Takaori K, Kawaguchi Y, Mizumoto M, Kawaguchi M, Koizumi M. et al Laparoscopic common hepatic artery ligation and staging followed by distal pancreatectomy with en bloc resection of celiac artery for advanced pancreatic cancer.”. Asian J Endosc Surg 2011; Nov; 4 (04) 199-202 https://doi.org/10.1111/j.1758-5910.2011.00105
- Sato T, Inoue Y, Takahashi Y, Mise Y, Ishizawa T, Tanakura K. et al Distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery. J Gastrointest Surg 2017; Jan; 21 (05) 910-917 https://doi.org/10.1007/s11605-017-3366-5