Kim Sung Hyun, Choi Seo Hee, Chung Moon Jae, Lee Ik Jae, Koom Woong Sub, Kang Chang Moo
Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2025 Aug 31;29(3):371-376. doi: 10.14701/ahbps.25-044. Epub 2025 Jun 26.
Although half of the patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed at an advanced stage, surgical interventions needed at this stage are currently limited. Carbon-ion radiotherapy (CIRT) has emerged as a promising treatment modality for PDAC owing to its superior physical and radiobiological properties. However, a major challenge in this treatment is the proximity of the pancreas to radiosensitive organs including the stomach and duodenum, which limits dose escalation and increases the risk of severe complications, including ulceration and perforation. Herein, we report our experience with laparoscopic omentopexy as a spacer technique before CIRT in patients with locally advanced PDAC. A 55-year-old female with locally advanced PDAC, secondary to unreconstructible superior mesenteric vein involvement, who had planned to undergo CIRT. After 28 cycles of modified FOLFIRINOX, the tumor size demonstrated slight shrinkage. However, the tumor abutted the posterior wall of the stomach, raising concerns about ensuring a sufficient safety margin while delivering a curative dose of CIRT. Therefore, laparoscopic omentopexy was performed for spacer implantation between the pancreas and stomach. The patient was discharged on the postoperative day 2 without any complications. One month after the omentopexy, the patient completed all 12 fractions of the CIRT with no acute complications, except for grade 1 fatigue. After completing CIRT, the patient underwent regular follow-up evaluations. Laparoscopic omentopexy before CIRT in patients with locally advanced PDAC could enhance therapeutic efficacy.
尽管一半的胰腺导管腺癌（PDAC）患者在晚期才被诊断出来，但目前这个阶段所需的手术干预措施有限。碳离子放疗（CIRT）因其卓越的物理和放射生物学特性，已成为一种有前景的PDAC治疗方式。然而，这种治疗的一个主要挑战是胰腺靠近包括胃和十二指肠在内的放射敏感器官，这限制了剂量的增加，并增加了严重并发症的风险，包括溃疡和穿孔。在此，我们报告我们在局部晚期PDAC患者中，将腹腔镜大网膜固定术作为CIRT前的间隔技术的经验。一名55岁女性，因肠系膜上静脉不可重建受累继发局部晚期PDAC，计划接受CIRT。在进行28个周期的改良FOLFIRINOX方案治疗后，肿瘤大小略有缩小。然而，肿瘤紧邻胃后壁，这引发了在给予根治性剂量的CIRT时确保足够安全 margins 的担忧。因此，进行了腹腔镜大网膜固定术，在胰腺和胃之间植入间隔物。患者术后第2天出院，无任何并发症。大网膜固定术后1个月，患者完成了全部12次CIRT治疗，除1级疲劳外无急性并发症。完成CIRT后，患者接受定期随访评估。局部晚期PDAC患者在CIRT前进行腹腔镜大网膜固定术可提高治疗效果。
