En Bloc Multivisceral Resection and Portal Vein Thrombectomy for Metastatic Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report.

Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors that typically exhibit a low malignant potential and an indolent clinical course; however, up to 10-15% of cases can manifest aggressive features, including vascular invasion and synchronous distant metastases. We report the case of a patient diagnosed with an aggressive pancreatic SPN associated with extensive local invasion, a 5 cm portal vein tumor thrombus, and synchronous hepatic metastases. The patient underwent an extensive, aggressive multi-visceral resection encompassing a distal pancreatectomy, splenectomy, superior hemigastrectomy, distal esophagectomy, and a portal vein thrombectomy with primary vascular repair. Follow-up imaging demonstrated stable hepatic disease with an increase in cystic-appearing lesions, while follow-up laboratory evaluations confirmed the complete normalization of biochemical and hematological parameters. Clinically, the patient experienced a satisfactory postoperative course, presenting with no compromise in nutritional status, adequate tolerance of oral intake, and optimal functional capacity, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0, performing all activities of daily living autonomously and without limitations. This case underscores that aggressive multi-visceral surgical resection with cytoreductive intent is a technically feasible and highly beneficial strategy for metastatic SPN, as it can favorably modify the disease's biological behavior, reduce overall tumor burden, and achieve remarkable clinical and functional stability.