Abstract

Mirzagaleb Nigmatovich Tillyashaykhov, Abrorjon Akhmedjanovich Yusupbekov*, Yusuf Kendjaevich Yakubov, Surat Nematovich Temirov, Bobur Bakhtiyarovich Saipov, Yanfang Zheng

ABSTRACT

Introduction: Super-extended surgeries performed for locally advanced distal pancreatic cancer are extremely rare and unique procedure, which require high experience and top tier hospital level. Aim of the study is to share our own clinical experience of radical corporocaudal pancreatectomy with resection of the coeliac trifurcation. Case Presentation: A 54-year-old female patient, from Uzbekistan, with locally advanced pancreatic (corporocaudal localization) cancer. At initial diagnosis ultrasound revealed formation, measuring 62x37x48 mm. Contrast-enhanced MSCT demonstrated the mass, measuring 37×53×27 mm. The celiac trunk has a diameter of 6.0 mm, with a 20% stenosis at its origin and 30% stenosis at its trifurcation. The common hepatic artery in its proximal third is narrowed to 2.2 mm (55%) over a length of 9 mm; the splenic artery in its proximal third is narrowed to 1.8–2.5 mm (50–65%) over 2.5 cm; the left gastric artery shows critical narrowing at its origin (up to 80%). Core biopsy revealed a pancreatic adenocarcinoma. Given the initial stage of the disease, 8 cycles of chemotherapy with FOLFIRINOX scheme were administered to the patient. Control MSCT revealed the stabilization of the process. Given the local advancement, ineffectiveness of chemotherapy and absence of distant metastases, the multidisciplinary tumor team proposed performing a combined surgical intervention – modified Appleby operation was performed with simultaneous resection of the coeliac trunk with its branches: common hepatic, splenic and left gastric arteries. Conclusion: Neoadjuvant chemotherapy for locally advanced pancreatic cancer makes possible surgical treatment for initially unresectable cases. In the presence of collaterals that allow maintaining satisfactory blood supply to the liver, it is advisable to perform distal pancreatectomy with resection of the celiac triangle.