PMC5279107_01
(A) Abdominal contrast-enhanced CT and (B) contrast-enhanced MRI showed a 3 x 3 cm solid hypovascular tumor in the head of the pancreas (green arrow). (C, D) PET-CT showed a mass with SUVmax 11.6 located in the pancreatic head and no distant organ metastasis. CT = computed tomography, MRI = magnetic imaging resonance, PET = positron emission tomography.
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F1
Abdominal contrast-enhanced computed tomography (CT) scan and magnetic resonance (MR) imaging revealed a 3 x 3 cm solid hypovascular mass in the head of the pancreas (Fig. 1A, B). There was no evidence of lymph node metastasis, peritoneal dissemination, or distant organ metastasis (Fig. 1C, D).
(A) Multidisciplinary team meeting, (B) a-92-older patient with malnutrition, and (C, D) the status of the patient treated by enteral nutrition and parenteral nutrition.
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F2
MDT meeting consisted of surgeons, physicians, clinical and medical oncologists, radiologists, pathologists, and clinical nurse specialists (CNSs) were organized to make clinical decisions (Fig. 2). Third, percutaneous transhepaticcholangial drainage (PTCD) was used to relieve jaundice and bile reinfusion (Fig. 2).
(A) On postoperative day (POD)2, the patient achieved out-of-bed activity. (B) On POD13, she was discharged.
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F3
On POD2, the nasogastric tuber was removed and the patient achieved out-of-bed activity (Fig. 3A). On POD8, drainage tubes were removed and she was discharged on POD13 (Fig. 3B).
(A) Gross appearance of resected specimen: the lesion located in the head of the pancreas (red arrow), (B) histopathology of the pancreatic ductal adenocarcinoma (PDAC) (H&E x 100). The tumor represented moderately differentiated ductal adenocarcinoma.
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F4
Histopathological and immunohistochemical examination of the resected specimen revealed that it is the moderately differentiated pancreatic duct adenocarcinoma without lymph nodes metastasis (Fig. 4).
(A) 1 - Showing 5 trocars in a V-shape; 2, 3 - dividing the gastrocolic ligament, exposing the pancreas, SMV, and SPV; and 4 - ligating the GDA. (B) 1, 2 - The jejunum and stomach dissection (linear stapler); 3 - pancreatic neck division; 4 - dissecting the uncinate process of pancreas; and 5 - the bile duct division. (C) 1 - The end-to-side pancreaticojejunostomy (duct-to-mucosa); 2 - the end-to-side choledochojejunostomy; 3 - the gastrojejunostomy; 4 - the specimen removed; and 5 - placing 2 drainage tubes. GDA = gastroduodenal artery, SMV = superior mesenteric vein, SPV = splenetic vein.
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F5
Port placement adopted 5 trocars in a V-shape depicted in Fig. 5A.