A 61-Year-Old Woman With Locally Advanced Pancreatic Adenocarcinoma Managed With Neoadjuvant FOLFIRINOX, Total Pancreatectomy, Splenectomy, Portal Vein and Common Hepatic Artery Resection, and Combined Vascular Reconstruction Using Splenic Artery Transposition: A Case Report.
Javier Chapochnick, Carlos Derosas, Juan Alejandro Gonzalez
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Case in brief
A 61-year-old woman presented with progressive jaundice and CA 19-9 of 210 U/mL. Biopsy confirmed pancreatic ductal adenocarcinoma, and imaging showed portal vein and common hepatic artery involvement without distant metastases. After 12 cycles of FOLFIRINOX, vascular involvement persisted. She underwent total pancreatectomy and splenectomy with resection of a 4-cm portal vein segment and the common hepatic artery. Portal flow was restored by end-to-end anastomosis, and hepatic arterial inflow by splenic artery transposition. Pathology showed a 1.3-cm tumour, 2 of 41 involved nodes, and negative margins. A chylous fistula was managed; a pulmonary metastasis was resected at 15 months. She died from severe pneumonia 27 months after surgery, without locoregional recurrence.
What made this case unusual
The operation combined portal vein and common hepatic artery resection during total pancreatectomy, with portal venous end-to-end anastomosis and splenic artery transposition to restore hepatic arterial inflow.
Diagnostic / clinical pearl
In selected locally advanced pancreatic adenocarcinoma with major vascular involvement and no distant metastases, this report demonstrates a reconstructive approach combining portal vein anastomosis with splenic artery transposition after arterial resection.