Jouffret Lionel, Guilbaud Theophile, Turrini Olivier, Delpero Jean-Robert
Department of Surgical Oncology, Institut PaoliCalmettes, Marseille 13009, France.
World J Clin Cases. 2018 Aug 16;6(8):214-218. doi: 10.12998/wjcc.v6.i8.214.
We report the case of a 56-year-old woman with pancreatic adenocarcinoma (PA) discovered during an episode of febrile jaundice. A computed tomography (CT) scan showed a mass in the head of the pancreas with circumferential infiltration of the superior mesenteric vein (SMV) and dilatation of the biliary and pancreatic ducts without metastases. The patient benefited from neoadjuvant chemotherapy (FOLFIRINOX) followed by radio-chemotherapy (45 Gy) and chemotherapy (LV5FU2). The revaluation CT revealed SMV thrombosis without portal vein (PV) thrombosis. There was no contact of the tumor with the PV. Pancreatoduodenectomy with combined resection of the SMV was performed with no reconstruction of this venous axis after confirmation of adequate PV, splenic, and left gastric venous flow and the absence of bowel ischemia. The pathological diagnosis was pT4N1R0 PA. There were no bowel angina issues during the follow-up period. At 15 mo after surgery, the patient died of metastatic recurrence.
我们报告了一例56岁女性，在发热性黄疸发作期间发现患有胰腺腺癌（PA）。计算机断层扫描（CT）显示胰头有一肿块，肠系膜上静脉（SMV）有环形浸润，胆管和胰管扩张，无转移。患者接受了新辅助化疗（FOLFIRINOX），随后进行了放化疗（45 Gy）和化疗（LV5FU2）。复查CT显示SMV血栓形成，无门静脉（PV）血栓形成。肿瘤与PV无接触。在确认PV、脾静脉和胃左静脉血流充足且无肠缺血后，进行了胰十二指肠切除术并联合切除SMV，未对该静脉轴进行重建。病理诊断为pT4N1R0 PA。随访期间无肠绞痛问题。术后15个月，患者死于转移性复发。
