# Laparoscopic Distal Pancreatectomy for Lymph Node Metastasis around Splenic Artery from Hepatocellular Carcinoma in a Patient with Portal Annular Pancreas

## TL;DR

A rare case of lymph node metastasis from hepatocellular carcinoma was successfully treated with laparoscopic distal pancreatectomy in a patient with a unique pancreatic anatomy.

## Contribution

This paper presents a rare clinical case demonstrating the successful use of laparoscopic distal pancreatectomy for treating lymph node metastasis in a patient with portal annular pancreas.

## Key findings

- Laparoscopic distal pancreatectomy successfully resected lymph node metastasis involving the splenic artery and pancreas.
- The patient remained recurrence-free for over four years post-surgery despite a grade B pancreatic fistula.
- The case highlights the importance of considering unique anatomical variations like portal annular pancreas during surgical planning.

## Abstract

Lymph node metastases after hepatocellular carcinoma (HCC) resection exist, although they are not common. However, solitary metastasis to the splenic artery lymph node with suspected pancreatic invasion after HCC resection is rare. In certain cases, surgical resection is performed to improve patient outcomes. We report a case of lymph node metastasis resected by laparoscopic distal pancreatectomy (LDP) in a patient with a unique anatomical anomaly known as portal annular pancreas (PAP).

A 79-year-old Japanese man underwent laparoscopic left lateral segmentectomy for HCC. Two months after the surgery, alpha-fetoprotein levels remained elevated. Plain computed tomography revealed a swollen lymph node along the splenic artery involving the pancreas and the PAP. We suspected a solitary metastasis to the lymph node around splenic artery with pancreatic invasion. LDP was performed for complete resection of lymph node metastasis. Although the patient developed a grade B postoperative pancreatic fistula, he was discharged on postoperative day 33 under conservative treatment of antibiotics. He has remained recurrence-free for 4 years and 3 months after surgery.

LDP was successfully performed for lymph node metastasis around the splenic artery in an HCC patient and resulted in long-term survival. Surgeons should be aware of the unique anatomical characteristics of PAP during LDP.