First description of extended and tailored fluorescence-guided lymphadenectomy during robotic distal pancreatosplenectomy: case report
Nenhuma Miniatura disponível
Citações na Scopus
0
Tipo de produção
article
Data de publicação
2023
Título da Revista
ISSN da Revista
Título do Volume
Editora
AME PUBLISHING COMPANY
Autores
Citação
JOURNAL OF VISUALIZED SURGERY, v.9, article ID 38, p, 2023
Resumo
Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct adenocarcinoma (PDAC) of the pancreatic body have become a well-established approach. To improve oncologic resection and lymph node (LN) dissection, technical alternatives have emerged on the last few years, such as the radical antegrade modular pancreatosplenectomy (RAMPS). While it is accepted that 12 LNs should be retrieved during distal pancreatosplenectomies, during RAMPS procedure the mean harvest is described to be 21 LNs (range, 11–30). With the objective of performing extended and tailored lymphadenectomies during robotic distal pancreatosplenectomies, we developed a novel technique for LN dissection with the use of real-time near-infrared robotic fluorescence and direct injection of indocyanine green in the pancreas as a contrast agent. Case Description: The patient presented pathologically confirmed PDAC on the body of the pancreas and was submitted to totally robotic distal pancreatosplenectomy. After exposing the pancreatic body and under intraoperative sonography guidance, 1 mL of indocyanine green was injected on the pancreas just proximal to the tumor. Using robotic fluorescence, we could clearly identify the lymphatic drainage of the pancreatic body, in order to perform fluorescence-guided, extended and tailored lymphadenectomy. Operative time was 4 hours and 43 minutes. Forty-three LNs were retrieved. Surgical margin was free from neoplasia. Postoperative period was uneventful. Conclusions: Fluorescence-guided extended lymphadenectomy with intrapancreatic injection of indocyanine green is a novel technique that may improve oncological results and staging during robotic distal pancreatosplenectomies for the treatment of PDAC of the pancreatic body.
Palavras-chave
case report, fluorescence, lymphadenectomy, Pancreatic duct adenocarcinoma (PDAC), robotic pancreatectomy
Referências
- Cuschieri A., Laparoscopic surgery of the pancreas, J R Coll Surg Edinb, 39, pp. 178-184, (1994)
- Velanovich V., Case-control comparison of laparoscopic versus open distal pancreatectomy, J Gastrointest Surg, 10, pp. 95-98, (2006)
- Guerrini GP, Lauretta A, Belluco C, Et al., Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis, BMC Surg, 17, (2017)
- Melvin WS, Needleman BJ, Krause KR, Et al., Robotic resection of pancreatic neuroendocrine tumor, J Laparoendosc Adv Surg Tech A, 13, pp. 33-36, (2003)
- Orth M, Metzger P, Gerum S, Et al., Pancreatic ductal adenocarcinoma: biological hallmarks, current status, and future perspectives of combined modality treatment approaches, Radiat Oncol, 14, (2019)
- Zhu LL, Wu Z, Li RK, Et al., Deciphering the genomic and lncRNA landscapes of aerobic glycolysis identifies potential therapeutic targets in pancreatic cancer, Int J Biol Sci, 17, pp. 107-118, (2021)
- Postlewait LM, Kooby DA., Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?, J Gastrointest Oncol, 6, pp. 406-417, (2015)
- Strasberg SM, Drebin JA, Linehan D., Radical antegrade modular pancreatosplenectomy, Surgery, 133, pp. 521-527, (2003)
- Choi SH, Kang CM, Hwang HK, Et al., Robotic anterior RAMPS in well-selected left-sided pancreatic cancer, J Gastrointest Surg, 16, pp. 868-869, (2012)
- Zhou Y, Shi B, Wu L, Et al., A systematic review of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas, HPB (Oxford), 19, pp. 10-15, (2017)
- Society JP., Classification of pancreatic carcinoma, (2003)
- Dreyer SB, Jamieson NB, Upstill-Goddard R, Et al., Defining the molecular pathology of pancreatic body and tail adenocarcinoma, Br J Surg, 105, pp. e183-e191, (2018)
- Schwarz RE, Smith DD., Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database, Ann Surg Oncol, 13, pp. 1189-1200, (2006)
- Morales-Oyarvide V, Rubinson DA, Dunne RF, Et al., Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival, Br J Cancer, 117, pp. 1874-1882, (2017)
- Erdem S, Bolli M, Muller SA, Et al., Role of lymphadenectomy in resectable pancreatic cancer, Langenbecks Arch Surg, 405, pp. 889-902, (2020)
- Kayahara M, Nagakawa T, Futagami F, Et al., Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas, Cancer, 78, pp. 2485-2491, (1996)
- Tanaka K, Nakamura T, Asano T, Et al., Pancreatic body and tail cancer and favorable metastatic lymph node behavior on the left edge of the aorta, Pancreatology, 20, pp. 1451-1457, (2020)