Nicolae Bacalbasa1,2, Irina Balescu3, Mihai Dimitriu2,4, Cristian Balalau5,6, Florentina Furtunescu7, Florentina Gherghiceanu8, Daniel Radavoi9,10, Camelia Diaconu11,12, Ovidiu Stiru13,14, Cornel Savu15,16, Vladislav Brasoveanu17, Claudia Stoica18,19, Ioan Cordos15,16. 1. Department of Visceral Surgery, Center of Excellence in Translational Medicine Fundeni Clinical Institute, Bucharest, Romania; nicolae_bacalbasa@yahoo.ro. 2. Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 3. Department of Surgery Ponderas Academic Hospital, Bucharest, Romania. 4. Department of Obstetrics and Gynecology, St. Panteleimon Emergency Hospital, Bucharest, Romania. 5. Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 6. Department of Surgery, St. Panteleimon Emergency Hospital, Bucharest, Romania. 7. Department of Public Health and Management, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 8. Department of Marketing and Medical Technology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 9. Department of Urology, Prof. Dr. Th. Burghele Clinical Hospital, Bucharest, Romania. 10. Department of Urology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 11. Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 12. Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania. 13. Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania. 14. Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 15. Department of Thoracic Surgery, Marius Nasta National Institute of Pneumology, Bucharest, Romania. 16. Department of Thoracic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 17. Department of Visceral Surgery, Center of Excellence in Translational Medicine Fundeni Clinical Institute, Bucharest, Romania. 18. Department of Surgery, Ilfov County Hospital, Bucharest, Romania. 19. Department of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Abstract
BACKGROUND: Locally advanced pancreatic cancer invading the surrounding vascular structures has long been considered as unresectable and, therefore, patients were usually submitted to palliative chemotherapy. CASE REPORT: We present the case of a 44-year-old male investigated for weight loss and abdominal pain and diagnosed with a locally advanced pancreatic tumor invading the celiac axis. An endoscopic ultrasound was performed and a biopsy was retrieved demonstrating the presence of a moderately differentiated pancreatic adenocarcinoma. After discussing with the patient the risks and the benefits of performing an extended surgical procedure, the patient consented to distal pancreatectomy en bloc with celiac axis resection. Postoperatively, the patient was submitted to low-molecular-weight heparin therapy for 3 weeks followed by oral anticoagulant for 2 months. Histopathological studies confirmed the presence of a moderately differentiated pancreatic adenocarcinoma invading the celiac axis and described negative resection margins. CONCLUSION: Although celiac axis invasion has been considered for a long period of time as a sign of unresectable disease due to the high rates of perioperative complications, it seems that in selected cases, surgery can be safely performed with curative intent, especially if negative resection margins are achieved.
BACKGROUND: Locally advanced pancreatic cancer invading the surrounding vascular structures has long been considered as unresectable and, therefore, patients were usually submitted to palliative chemotherapy. CASE REPORT: We present the case of a 44-year-old male investigated for weight loss and abdominal pain and diagnosed with a locally advanced pancreatic tumor invading the celiac axis. An endoscopic ultrasound was performed and a biopsy was retrieved demonstrating the presence of a moderately differentiated pancreatic adenocarcinoma. After discussing with the patient the risks and the benefits of performing an extended surgical procedure, the patient consented to distal pancreatectomy en bloc with celiac axis resection. Postoperatively, the patient was submitted to low-molecular-weight heparin therapy for 3 weeks followed by oral anticoagulant for 2 months. Histopathological studies confirmed the presence of a moderately differentiated pancreatic adenocarcinoma invading the celiac axis and described negative resection margins. CONCLUSION: Although celiac axis invasion has been considered for a long period of time as a sign of unresectable disease due to the high rates of perioperative complications, it seems that in selected cases, surgery can be safely performed with curative intent, especially if negative resection margins are achieved.
Authors: James R Butler; Syed A Ahmad; Matthew H Katz; Jessica L Cioffi; Nicholas J Zyromski Journal: HPB (Oxford) Date: 2016-02-01 Impact factor: 3.647
Authors: Mark J Truty; Jill J Colglazier; Bernardo C Mendes; David M Nagorney; Thomas C Bower; Rory L Smoot; Randall R DeMartino; Sean P Cleary; Gustavo S Oderich; Michael L Kendrick Journal: J Am Coll Surg Date: 2020-05-15 Impact factor: 6.113
Authors: W Kimura; I Han; Y Furukawa; E Sunami; N Futakawa; T Inoue; H Shinkai; B Zhao; T Muto; M Makuuchi; H Komatsu Journal: Hepatogastroenterology Date: 1997 Mar-Apr