EXTENDED PANCREATICODUODENECTOMY FOLLOWED BY VASCULAR RECONSTRUCTION IN INCIDENTALLY DIAGNOSED BORDERLINE RESECTABLE SPINDLE CELL NEOPLASM OF PANCREAS shr.riyaz@gmail.com

211-03

EXTENDED PANCREATICODUODENECTOMY FOLLOWED BY VASCULAR RECONSTRUCTION IN INCIDENTALLY DIAGNOSED BORDERLINE RESECTABLE SPINDLE CELL NEOPLASM OF PANCREAS

5

Nepal

Oral or Poster

Pancreatic tumors involving major vascular structures have traditionally been considered inoperable due to high perioperative risk and uncertain oncological benefit. However, with advances in surgical techniques and multi-disciplinary perioperative care, this dogma is challenged as vascular resection and reconstruction can be safely performed in selected patients, potentially improving overall survival.

We present a case of a 34-year-old female, incidentally diagnosed with a pancreatic mass involving the head and body during a routine health check. Triphasic CT revealed tumor compression of the portosplenic confluence. Following multidisciplinary review, an extended pancreaticoduodenectomy was planned with possible vascular resection.

Intra-operatively, the tumor in the pancreatic neck was found to invade the confluence of the portal vein, superior mesenteric vein, and splenic vein. Intraoperative ultrasound-guided pancreatic transection was performed, followed by en bloc resection and spleno-portal reconstruction using a tension-free vascular anastomosis. Postoperative Doppler ultrasound on days 1, 3, and 5 confirmed good vascular patency and flow. Histopathology revealed spindle cell neoplasm of the pancreas with all surgical margins free of tumor. The patient underwent four cycles of adjuvant doxorubicin and ifosfamide chemotherapy and remains under surveillance without recurrence to date.

This case underscores that vascular involvement in pancreatic tumors should not preclude curative intent surgery. In experienced hands, combined pancreatico-vascular resection and reconstruction can yield oncologically complete resection with durable vascular patency. The potential thrombotic risk is outweighed by the survival advantage conferred by margin-negative surgery, shifting the paradigm in the surgical management of borderline resectable pancreatic tumors.