Open Distal Pancreatectomy for Pancreatic Cancer

Carlos Fernandez-del Castillo, MD
Massachusetts General Hospital

Morgan L. Hennessy, MD, PhD
Massachusetts General Hospital

In this case, Dr. Carlos Fernandez-del Castillo at MGH performs and narrates an open distal pancreatectomy with splenectomy in a patient who has undergone neoadjuvant treatment for pancreatic adenocarcinoma. This is a unique case of a patient undergoing surgical resection after initial diagnosis of metastatic disease. The patient is a 69-year-old woman who initially presented with abdominal pain and bloating, and was found to have a 2-cm suspicious tumor in the body of her pancreas and biopsy-proven single liver metastasis. She was treated with an extended course of neoadjuvant chemotherapy, and re-staging scans showed significant response. Chemoradiation was completed, and the liver metastasis was no longer visible on imaging. 27 months after diagnosis she was taken to the operating room for distal pancreatectomy and splenectomy; no liver or peritoneal metastases were seen. Her postoperative course was overall uneventful, and she recovered well. Final surgical pathology demonstrated complete pathological response with no evidence of disease seen and 0/11 lymph nodes positive for malignancy.