Department of Visceral Surgery, Center of Excellence in Translational Medicine Fundeni Clinical Institute, Bucharest, Romania;
Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
In Vivo. 2021 Nov-Dec;35(6):3627-3631. doi: 10.21873/invivo.12669.
Locally advanced pancreatic cancer invading the surrounding vascular structures has long been considered as unresectable and, therefore, patients were usually submitted to palliative chemotherapy.
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.
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.
长期以来，局部晚期侵犯周围血管结构的胰腺癌被认为是不可切除的，因此，患者通常接受姑息性化疗。
我们报告了一例 44 岁男性，因体重减轻和腹痛就诊，诊断为局部晚期侵犯腹腔干的胰腺肿瘤。进行了内镜超声检查，并进行了活检，结果显示为中分化胰腺腺癌。与患者讨论了进行扩大手术的风险和益处后，患者同意进行胰体尾切除术联合腹腔干切除术。术后，患者接受低分子量肝素治疗 3 周，然后口服抗凝治疗 2 个月。组织病理学研究证实存在中分化胰腺腺癌侵犯腹腔干，且描述了无肿瘤残留的切缘。
尽管腹腔干侵犯长期以来被认为是不可切除疾病的标志，因为围手术期并发症发生率高，但似乎在某些选择病例中，可以安全地进行有治愈意图的手术，特别是如果达到了无肿瘤残留的切缘。
