Extended distal pancreatectomy for advanced pancreas neck cancer: technical aspect

초록

Aims: To investigate the clinical applicability of extended distal pancreatectomy in patients with pancreas neck cancer accompanied with distal pancreatic atrophy, with special emphasis on the technical aspects in using the linear stapling device when the target organ is bulky. Methods: From March 2010 to September 2013, a total of 46 patients with pancreatic adenocarcinoma underwent radical pancreatic resection at our institute. Among them, 3 patients (6.5%) who underwent extended distal pancreatectomy were reviewed retrospectively. A linear stapling device and a vise-grip locking pliers were used to resect distal pancreas, duodenal first portion, and distal common bile duct, en-bloc. In 2 patients, the invaded portion of the superior mesenteric vein was also resected, with reconstruction using an artificial graft. The gastrointestinal continuity was restored by Roux-en-Y hepaticojejunostomy, gastro- or duodenojejunostomy, and jejunojejunostomy, respectively. The postoperative complications and the follow-up data are also presented. Results: All the 3 patients presented with jaundice, and the pancreatic duct to parenchymal thickness ratio of the pancreas body were greater than 0.5. The operation required from 9 to 13 hours, and the estimated blood loss was from 1000 to 1800 mL. Grade A pancreatic fistula developed in all the cases, but none of them lethal. One patient suffered from long standing ascites drainage. Pathological staging was T3N1M0 in all patients. At the last follow-up, two patients were alive with liver metastasis at 6 and 10 postoperative months, respectively, and one patient died of liver metastasis at 4 months postoperatively. Conclusions: While the prognosis of the advanced pancreas neck adenocarcinoma is still dismal, an extended distal pancreatectomy can be a valid option, especially when the distal pancreas is atrophic. At least, the procedure is technically feasible, and further refinement is mandatory to improve the patient survi