Successful pancreaticoduodenectomy for ampullary carcinoma in a patient with diabetes and stable chronic lymphocytic leukemia: a case report emphasizing multidisciplinary optimization.

BACKGROUND

Pancreaticoduodenectomy (PD) for ampullary carcinoma carries significant risks, and the presence of hematologic comorbidities adds further complexity. While stable Chronic Lymphocytic Leukemia (CLL) is not a contraindication, it complicates perioperative risk stratification and infection control.

CASE PRESENTATION: A 66-year-old male with type 2 diabetes mellitus (DM) and stable, untreated Rai Stage I chronic lymphocytic leukemia (CLL) presented with a three-week history of painless obstructive jaundice. Imaging and biopsy confirmed ampullary carcinoma.

INTERVENTION: Following multidisciplinary team (MDT) optimization focusing on glycemic control (target 140-180 mg/dL), preoperative biliary drainage, infection prophylaxis, and immunologic surveillance, a pylorus-preserving PD (PPPD) was performed.

OUTCOME: The postoperative course was stable with no biochemical leak or clinically relevant postoperative pancreatic fistula (POPF). Histopathology revealed pT2N0 (Stage I) ampullary carcinoma (intestinal-type) with focal lymphovascular invasion (LVI). Interestingly, regional lymph nodes showed CLL infiltration but were negative for metastasis.

CONCLUSION

This case shows that structured MDT optimization and adherence to ERAS protocols enabled safe curative-intent PD in this patient with stable CLL and DM.