Laparoscopic assisted distal pancreatectomy for a patient with main duct intraductal papillary mucinous adenocarcinoma

Abstract

A 59-year-old female was admitted to our institution for further examination of a cystic tumor measuring 4cm in diameter in the body and tail of the pancreas that had been detected incidentally by a CT scan. Based on a preoperative diagnosis of non-invasive and localized main duct intraductal papillary mucinous carcinoma (IPMC) with further extensive imaging studies, we performed laparoscopic assisted distal pancreatectomy following careful pre- and intraoperative investigations. After the body and tail of the pancreas were mobilized from the retroperitoneum laparoscopically, the pancreas was transected using an ultrasonic dissector (CUSA) extracorporeally through a 6-cm upper-midline incision. During parenchymal transection of the pancreas, even small pancreatic ducts and vessels were exposed, tied and divided with the aid of CUSA. Postoperative histological study demonstrated an IPMC (pTis, pN0, M0, Stage 0). The patient recovered uneventfully and was discharged on the 12th postoperative day. In the present case, IPMC was successfully resected by a minimally invasive laparoscopy assisted surgery. This strategy can be a new optional treatment for a localized, non-invasive IPMC with accurate pre- and intraoperative diagnoses.