1. Introduction

2. Incision and Access to the Abdominal Cavity

3. Abdominal Exploration to Rule out Metastasis

4. Open Lesser Omentum to Expose the Pancreas

a. Preaortic Tissue Biopsy for Frozen

5. Hepatic Artery Exposure

a. Harvest Celiac Lymph Nodes

6. Follow Hepatic Artery to Celiac Trunk and Splenic Artery

7. Develop Plane Behind Pancreas

a. Send Additional Transection Margin for Frozen Section to Confirm Negative Margins

8. Pancreas Transection

a. Tie and Divide Splenic Artery Before Splenic Vein

9. Splenic Vessels Identification and Division

10. Develop Retropancreatic Plane over the Renal Vein Following it to the Left

11. Approach Through the Gastrocolic Omentum, Taking Down Short Gastrics and Mobilizing the Spleen to Deliver the Specimen

12. Hemostasis

13. Closure

14. Post-op Remarks

Distal pancreatectomy is a procedure performed most often for pancreatic tumors – both benign and malignant – but can also be indicated in the treatment of pancreatitis. The operation can be performed with an en-bloc resection of the spleen, or with splenic preservation – splenectomy is indicated for oncologic resection. The operative approach - laparoscopic, robotic, or open – is dictated by the patient and clinical scenario at hand. In this case, we perform an open distal pancreatectomy with splenectomy in a patient who has undergone neoadjuvant treatment for pancreatic adenocarcinoma. This is a unique case of a patient undergoing surgical resection after initial diagnosis of metastatic disease. The patient is a 69-year-old woman who initially presented with abdominal pain and bloating, and was found to have a 2 cm suspicious tumor in the body of her pancreas and biopsy-proven single liver metastasis. She was treated with an extended course of neoadjuvant chemotherapy, and re-staging scans showed significant response. Chemoradiation was completed and the liver metastasis was no longer visible on imaging. 27 months after diagnosis she was taken to the operating room for distal pancreatectomy and splenectomy; no liver or peritoneal metastases were seen. Her postoperative course was overall uneventful and she recovered well. Final surgical pathology demonstrated complete pathological response with no evidence of disease seen and 0/11 lymph nodes positive for malignancy. She is currently being followed with CT scans and tumor markers every three months by her medical oncology team and as of now, February 2022, there is no evidence of recurrence.

Watch this full-legnth, narrated surgical video of a distal pancreatectomy with splenectomy for pancreatic cancer performed by Dr. Carlos Fernandez-del Castillo at MGH.

DOI
Publication Date	2022/10/12
Article ID	339
Production ID	0339
Volume	2022
Issue	339
https://doi.org/10.24296/jomi/339

Open Distal Pancreatectomy for Pancreatic Cancer

Procedure Outline

Table of Contents