# Distal pancreatectomy with celiac axis resection (DP-CAR) and vascular reconstruction for locally advanced pancreatic adenocarcinoma: A case report

## TL;DR

A 40-year-old woman with advanced pancreatic cancer underwent a complex surgery and treatment, resulting in no disease recurrence after six months.

## Contribution

This case report demonstrates the effectiveness and safety of DP-CAR with celiac trunk reconstruction in locally advanced pancreatic cancer.

## Key findings

- DP-CAR with vascular reconstruction was successfully performed and resulted in no disease recurrence after six months.
- Multimodal treatment combining chemotherapy, radiotherapy, and surgery led to significant tumor regression and favorable outcomes.
- Anatomical variations were identified preoperatively, aiding in successful surgical planning and postoperative gastric perfusion.

## Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy that often presents at an advanced stage, especially when tumors involve the body and tail of the pancreas.

This case report describes a comprehensive treatment approach for a 40-year-old female with locally advanced PDAC of the pancreatic body, characterized by invasion into the celiac trunk and splenic artery. Initial management included nine courses of FOLFIRINOX chemotherapy and 27 sessions of radiotherapy, resulting in significant tumor regression. Subsequently, a complex surgical procedure involving corporocaudal resection of the pancreas, splenectomy, and celiac trunk prosthetic reconstruction using an autograft from the great saphenous vein was performed.

Preoperative CT imaging revealed a rare anatomical variation where the celiac trunk and superior mesenteric artery shared a common origin from the aorta, while the left gastric artery branched separately, facilitating postoperative gastric perfusion. Postoperative recovery was uneventful, with liver enzyme levels stabilizing within normal limits. Follow-up imaging six months after surgery confirmed the absence of disease recurrence and the maintained integrity of the vascular reconstruction.

This case highlights the importance of individualized treatment planning, the use of neoadjuvant therapy, and advanced surgical techniques to achieve favorable outcomes in patients with complex PDAC presentations.

•Modern technologies and advancements in diagnostic and surgical planning enable the successful execution of technically complex pancreatic operations, even in cases with body and tail invasion.•DP-CAR with celiac trunk prosthetic reconstruction proved to be effective and safe, as evidenced by the uneventful postoperative course and the absence of disease recurrence within six months after surgery.•Multimodal treatment, including chemotherapy combined with surgery, is also a crucial component of successful management.

Modern technologies and advancements in diagnostic and surgical planning enable the successful execution of technically complex pancreatic operations, even in cases with body and tail invasion.

DP-CAR with celiac trunk prosthetic reconstruction proved to be effective and safe, as evidenced by the uneventful postoperative course and the absence of disease recurrence within six months after surgery.

Multimodal treatment, including chemotherapy combined with surgery, is also a crucial component of successful management.