Distal pancreatectomy with celiac axis resection (DP-CAR) and vascular reconstruction for locally advanced pancreatic adenocarcinoma: A case report.

INTRODUCTION

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy that often presents at an advanced stage, especially when tumors involve the body and tail of the pancreas.

CASE PRESENTATION: This case report describes a comprehensive treatment approach for a 40-year-old female with locally advanced PDAC of the pancreatic body, characterized by invasion into the celiac trunk and splenic artery. Initial management included nine courses of FOLFIRINOX chemotherapy and 27 sessions of radiotherapy, resulting in significant tumor regression. Subsequently, a complex surgical procedure involving corporocaudal resection of the pancreas, splenectomy, and celiac trunk prosthetic reconstruction using an autograft from the great saphenous vein was performed.

DISCUSSION: Preoperative CT imaging revealed a rare anatomical variation where the celiac trunk and superior mesenteric artery shared a common origin from the aorta, while the left gastric artery branched separately, facilitating postoperative gastric perfusion. Postoperative recovery was uneventful, with liver enzyme levels stabilizing within normal limits. Follow-up imaging six months after surgery confirmed the absence of disease recurrence and the maintained integrity of the vascular reconstruction.

CONCLUSION

This case highlights the importance of individualized treatment planning, the use of neoadjuvant therapy, and advanced surgical techniques to achieve favorable outcomes in patients with complex PDAC presentations.