Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Portal Vein Reconstruction and Celiac Axis Resection for Pancreatic Neck-Body Cancer.

Background: Laparoscopic radical antegrade modular pancreatosplenectomy combined with celiac axis resection and portal vein reconstruction is a new procedure for the treatment of pancreatic cancer. This surgical technique may offer patients with pancreatic cancer involving the portal vein and celiac axis an opportunity for radical surgical resection. We aim to evaluate the short- and long-term efficacy and describe the surgical details of this technique.

Patients and methods: A 74-year-old man was diagnosed with pancreatic neck-body cancer, with a tumor size of 2.5 × 2.0 × 1.5 cm and local vascular invasion of the celiac axis, common hepatic artery, and portal vein. After four cycles of modified neoadjuvant folinic acid, fluorouracil, oxaliplatin, and irinotecan (FOLFIRINOX) therapy, reevaluation showed that the tumor size had considerably reduced, and the surrounding enlarged lymph nodes disappeared. Laparoscopic radical antegrade modular pancreatosplenectomy, combined with celiac axis resection and portal vein reconstruction, was performed.

Results: The operative time was 300 min, with blood loss of 200 mL. The drainage tube was removed 5 days postoperatively, and the patient was discharged 9 days later. The patient received eight cycles of modified FOLFIRINOX chemotherapy over the following month. After 15 months of follow-up, no tumor recurrence or metastasis was observed.

Conclusions: Laparoscopic radical antegrade modular pancreatosplenectomy, combined with celiac axis resection and portal vein reconstruction, is a safe and effective treatment option for patients with pancreatic neck-body cancer involving the celiac axis and portal vein.