engleski

Laparoscopic distal pancreatectomy for the treatment of neurodendocrine cancer

Aims: Although laparoscopic abdominal procedures gained world-wide popularity, this approach in pancreatic surgery is still rather rare. Here we report our long term result of our first laparoscopic distal pancreatectomy that we performed a year earlier due to neuronedocrine cancer in pancreatic body with splenic vein infiltration. Results: We present a 66-year-old male who underwent laparoscopic distal pancreatectomy with splenectomy for the treatment of neuroendocrine tumor in the pancreatic body. A four months earlier patient was submitted to elective laparoscopic cholecystectomy due to gallstones. As he had pain and discomfort with diarrhea after cholecystectomy he was submitted to diagnostic workup. In pancreatic body tumor sized 27 x 25 mm, was identified. Tumor was in close contact with spleenic vein. During preoperative evaluation, the patient underwent MSCT, EUS controlled cytopunction with cytological result of neuroendocrine tumor, chromogranin positive and Ki67 7%. Tumor markers level was normal (CEA 4.1 ad Ca 19-9 0.6). Laparoscopic distal pancreatectomy and splenectomy due to infiltration of splenic vein were performed. The postoperative course was uneventful. The histological review of the specimen demonstrated neuroendocrine carcinoma classified as pT3, pN0 (eleven nodes were examined). The grade of the cancer was G1 (cancer cells look the most like normal cells and have the best outlook) and R0 resection has been performed. Cytokeratin (CK AE1/AE3), neuron-specific enolase (NSE), chromogranin A and CD 56 glycoprotein was positive. Number of mitosis in the specimen was 2/10, Ki67 >20%. He was treated with adjuvant chemotherapy. During one year follow-up patient is well without recurrence. Conclusions: Minimally invasive pancreatic surgery still is not considered a standard procedure. Laparoscopic distal pancreatic resection is challenging but much more feasible due to lack of intestinal anastomoses offering the advantages of minimally invasive surgery. In selected cases with lesions in body or tail of the pancreas it should be considered as alternative to open approach.

pancreatectomy. laparoscopy; neureondocrine cancer

nije evidentirano