case_images: PMC8461296_01
case_images: Contrast-enhanced abdominal CT during treatment before the radical surgery. (A) Pretreatment. A retroperitoneal neoplastic lesion measuring about 6.5 cm x 8.3 cm was observed, which was located on the head and neck of the pancreas and manifested a moderate enhancement. The left gastric artery and splenic artery were covered in the tumor, and the common hepatic artery and the celiac trunk were got invaded. (B) 3 months after four courses of etoposide plus cisplatin neoadjuvant chemotherapy. The tumor size was significantly reduced and limited to 2.7 cm x 2.3 cm. (C) 5 months after four courses of etoposide plus cisplatin neoadjuvant chemotherapy. The tumor size was limited to 2.7 cm x 2.3 cm. (D) After six courses of neoadjuvant chemotherapy. The tumor size reached 3.0 cm x 2.2 cm.
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case_images: The left gastric artery and splenic artery were covered in the tumor, and the common hepatic artery and the celiac trunk were got invaded (Figure 1A). The patient then began 4 courses of etoposide (100 mg/m2 d1-3, Q21d) and cisplatin (50 mg/m2 d1, Q21d) neoadjuvant therapy, and finally achieved a partial response (PR) according to the Response Evaluation Criteria in Solid Tumors (RECIST). 3 months after the fourth neoadjuvant chemotherapy, an enhanced abdominal CT scan was requested and showed a significant decrease of the tumor size, which was limited to 2.7 cm x 2.3 cm (Figure 1B). 2 months later, the fifth and sixth course of the neoadjuvant chemotherapy was initiated as the reduction of the tumor size stopped (Figure 1C). The tumor had contacted the celiac trunk and its branches over 180  (Figure 1D).
case_images: Operative findings and surgical specimen. (A) From the operative exploration, the tumor quality was tough, and about 3.0 cm x 2.0 cm x 4.0 cm in diameter, infiltrating the neck and body of the pancreas, invading the lesser curvature, left adrenal gland, and the left diaphragm. The tumor also invaded the celiac trunk, the common hepatic artery, the left gastric artery, the splenic artery, the splenic vein, and its branches. (B) An Appleby procedure was performed to completely remove the tumor, tumor invaded vessels, the distal pancreas, and the spleen.
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case_images: The tumor also invaded the celiac trunk, the common hepatic artery, the left gastric artery, the splenic artery, the splenic vein, and its branches (Figure 2A). Finally, an Appleby procedure, the distal pancreatectomy with celiac artery resection, was performed to completely remove the tumor and tumor invaded arteries and veins (Figure 2B).
case_images: Contrast-enhanced abdominal CT after surgery. (A) 6 days after the radical surgery. The distal pancreas, spleen, and celiac trunk were absent. (B) 8 months after the radical surgery. No signs of recurrence or metastasis were found.
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case_images: The postoperative CT scan demonstrated an uneventful perioperative course, and the patient was discharged 7 days after the surgery (Figure 3A). The latest follow-up was 8 months after surgery, and no signs of recurrence or metastasis were found in the CT scan (Figure 3B).