Background: Radical resection remains the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC), with distal pancreatectomy and splenectomy being the standard surgical approach for malignant lesions in the body & tail of the pancreas. Traditional procedures necessitate the resection of distal pancreatic parenchyma and spleen, which can increase the risks of postoperative complications, such as new-onset diabetes mellitus and heightened susceptibility to infections. However, regarding pancreatic neck malignancies, standard distal pancreatectomy can easily lead to excessive loss of normal pancreatic tissues, and whether the spleen can be preserved is still controversial. The presenting article (with surgical video presentation) introduces a case of central pancreatectomy (CP) combined with sub-adventitial divestment and triangle operation for early-stage pancreatic neck cancer.
Methods: A 74-year-old female with early-stage pancreatic cancer who had a prior history of type II diabetes mellitus presented with a tumor located in the neck of the pancreas, close to the common hepatic artery and portal vein. To optimize the preservation of pancreatic parenchyma, a central pancreatectomy was performed.
Results: The surgical procedure was completed in 210 minutes, with an intraoperative blood loss of 200mL. Postoperative pathological analysis revealed moderately differentiated adenocarcinoma (pT1N0M0), with negative resection margins. No complications, such as pancreatic fistula or hemorrhage, occurred following the operation, and there was no exacerbation of diabetes mellitus upon discharge.
Conclusion: CP combined with sub-adventitial divestment and triangle operation is an option for treating early-stage pancreatic neck malignants. This technique may serve as a viable alternative to traditional distal pancreatectomy, which maximizes the preservation of normal pancreatic parenchyma and its endocrine and exocrine functions while achieving radical tumor resection. However, the long-term outcome of this surgical strategy, such as remnant pancreas and local lymph node recurrence rate needs to be studied in future RCT studies.