PMC3874893_01
Perioperative surgical outcomes. Low attenuated pancreatic tumor located to the pancreatic body (A) with obstructive distal pancreatic duct dilatation (B) was noted on pre-operative radiologic images. The mass was confined to the pancreatic body with intact fascia layer between the pancreas and left adrenal gland. In addition, tumor was apart from celiac axis more than 2 cm. Therefore, it was possible to be removed safely by modified anterior RAMPS [note the dissection plane, white dotted line, (A)]. Robot-assisted anterior RAMPS was performed, and pathology examination revealed that the tumor was a pancreatic ductal adenocarcinoma with pT3N0M0, stage IIA (C and D). Postoperative adjuvant radiotherapy was given (E). Postoperative CA 19-9 declined and remained within the normal range (F). *Soft tissue around celiac axis. pP, proximal pancreas; dP, distal pancreas; SAO, the origin of the splenic artery; SV, the junction of splenic vein to superior mesenteric vein; RAMPS, radical antegrade modular pancreatosplenectomy.
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F1
On preoperative axial imaging, he had a suspicious mass-like lesion confined to the pancreas, which was suggestive of pancreatic cancer (Fig. 1A and B). The left gastric vein with soft tissue around celiac trunk and common hepatic artery were dissected (Fig. 1C). Both the pancreatic resection margin and the tangential posterior margin were free of carcinoma (Fig. 1D). The patient received only postoperative adjuvant radiotherapy around the tumor bed (total 55.67 Gy/19 fractions, daily 2.93 Gy) (Fig. 1E). His CA 19-9 remained within normal limits after surgery (Fig. 1F), and the patient survived for more than five years without cancer recurrence.