Pancreaticoduodenectomy and Superior Mesenteric Vein Resection Without Reconstruction for Locally Advanced Pancreatic Cancer

Excerpt

An otherwise healthy 57-year-old male was diagnosed with pancreatic adenocarcinoma in May of 2016. He had a CA19-9 level of 2700 units/ml at diagnosis and was deemed unresectable due to superior mesenteric artery (SMA) encasement and superior mesenteric vein (SMV) occlusion. Over the ensuing 8 months, he received 2 cycles of gemcitabine and paclitaxel protein-bound (Abraxane, Celgene Corporation), followed by external beam radiation with concurrent paclitaxel protein-bound on protocol, and an additional 2 cycles of doublet chemotherapy. Serial imaging showed no evidence of metastases, a decrease in primary tumor size, and diminished SMA involvement (< 180 abutment), but persistent unreconstructible SMV occlusion (Figs. 1 and 2). His CA19-9 level decreased to 8 units/ml. Re-evaluation with new imaging at our institution revealed a patent porto-splenic confluence and extensive venous collateralization (Figs. 2 and 3). Though his primary lesion remained locally advanced pancreatic cancer (LAPC) by currently accepted definitions, a thorough evaluation in our multidisciplinary pancreas cancer clinic determined exploration possible given his excellent therapy response and robust collateralization.

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