MINOR HEPATOPANCREATICODUODENECTOMY FOR PANCREATIC NET WITH GALL BLADDER MASS saurabh_galodha@yahoo.com

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MINOR HEPATOPANCREATICODUODENECTOMY FOR PANCREATIC NET WITH GALL BLADDER MASS

2

India

Video

Hepato-pancreatico-duodenectomy (HPD) is performed usually in patients with carcinoma Gall bladder involving the pancreatico-duodenal groove or when there is suspicion of a dual malignancy in periampullary region and gall bladder.

55-year-old male with h/o Pain right hypochondrium,vomiting & weight loss found to have a cystic lesion near 2nd part duodenum during evaluation.CT scan showed 7x5 cm lesion in head of pancreas and irregular mural thickening in fundus and body of gall bladder. EUS reported 6x5 cm cystic mass Uncinate process of pancreas. FNA Biopsy was Well Differentiated NET Grade 1, Ki-67 – 1%. DOTANOC scan had SSTR expressing lesion in duodenum with loss of planes with pancreas with thickening in fundus and body of Gallbladder

Minor Hepatopancreaticoduodenectomy (HPD) with FJ was performed. 6x5 cm tumor in head & uncinate process of pancreas. Mesocolon infiltration + Thickening in fundus and body of gallbladder. PD – 2mm. CHD – 5 mm. No Pringle’s manouever. Pancreatico-jejunal anastomosis by invagination. Hepatico-jejunostomy done with interrupted PDS 5-0. Duration of Surgery -12 hours. Blood loss:500 ml. No intra-op blood transfusion. Post-operative Course: Orals started on POD3. Grade B POPF which required drainage. Discharged on POD 21

A Minor Hepatoma-pancreatico-duodenectomy can be safely performed in patients with suspicion of dual malignancy involving periampullary region and gallbladder (pancreatic NET with ?Ca GB in this case) with excellent results.

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