Laparoscopic pancreaticoduodenectomy after endovascular repair for abdominal aortic aneurysm

Abstract

INTRODUCTIONMost gastroenterological surgeries, even pancreatic surgery, can now be performed laparoscopically. However, the management of concomitant abdominal aortic aneurysm (AAA) and intra-abdominal malignancy is controversial. The performance of endovascular repair (EVAR) for AAA has been increasing; however, there is no report of laparoscopic pancreaticoduodenectomy after EVAR.PRESENTATION OF CASEA pancreatic tumor was detected during follow-up after EVAR for AAA. The enlarging tumor was diagnosed as an intraductal papillary mucinous tumor with a nodule. Laparoscopic pancreaticoduodenectomy was safely performed. After laparoscopic dissection around the pancreas head, an additional incision was made in the upper abdomen, and pancreatic reconstruction was performed through the incision. In spite of grade B pancreatic fistulae, the patient recovered with medical therapy. The pathological diagnosis was intraductal papillary mucinous adenoma with small foci of carcinoma in situ. The patient has been well with neither recurrence of the tumor nor any cardiovascular events for 18 months.DISCUSSIONThe management of concomitant malignancy and AAA is challenging, especially in patients with a pancreatic tumor. The reasons for the rarity of treatment include prognosis, anatomical vicinity, and postoperative complications. EVAR reduces retroperitoneal adhesions. A laparoscopic approach provides a small operative field and decreases mutual interference with AAA. Moreover, reconstruction is performed through an upper abdominal incision apart from the AAA. Hand-sewing provides more reliable stability of the anastomosis.CONCLUSIONThe increasing frequency of performance of EVAR for AAA and subsequent computed tomography may help to detect malignancy. Laparoscopic surgery appears to be a valid approach to malignancy after EVAR.

Stage II Pancreatic Adenocarcinoma after Endovascular Repair of Abdominal Aortic Aneurysm: A Case Report and Literature Review

“…It is controversial to simultaneously treat concomitant AAA and malignancies in the adjacent region, especially pancreatic tumors. We systematically searched online literature databases (PubMed, Wanfang, and CNKI) for articles containing “gastrointestinal tumor”, “pancreatic cancer”, and “abdominal aortic aneurysm.” We identified a total of 20 cases of pancreatic lesions with AAA and summarized the patients’ age, gender, aneurysm size, treatment method, interval time, pathology, tumor stage, and prognosis ( Table 1 ) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Fifteen cases were males, one was female and four were undefined.…”

“…However, the surgical strategies for such cases are very challenging for both general and vascular surgeons due to the surgical sequence, interval and expectation [ 20 , 21 , 22 ]. Many reports on AAA complicated with the gastrointestinal already exist; however, reports of pancreatic cancer are limited [ 5 , 6 , 23 ]. Abdullah et al [ 24 ] supported the necessity of simultaneous treatment of malignant tumors and AAA in life-threatening cases.…”

“…However, a long-term follow-up was not performed and no information regarding further progression of the patient were available [ 5 ]. In 2013, Masahiko et al [ 6 ] investigated a patient with AAA who underwent EVAR and reported a pancreatic mass two years after EVAR. Thus, a laparoscopic pancreaticoduodenectomy (LPD) was carried.…”

Synchronous Gastrointestinal Tumor and Abdominal Aortic Aneurysm or Dissection Treated with Endovascular Aneurysm Repair Followed by Tumor Resection

“…The management of this clinical situation remains a therapeutic dilemma, as evidenced by the disparity in published case reports, series, and recommendations [1, 9–11]. Many variables in the decision-making process should be considered, including surgeon's experience and preference, local medical level, aneurysm or dissection size, and type and stage of cancer [12, 13].…”

Laparoscopic pancreaticoduodenectomy in A-92-older Chinese patient for cancer of head of the pancreas

“…LPD introduced in 1990s involves the same techniques as its open counterpart including dissection of the duodenum and the head of the pancreas, and reconstruction of the gastrointestinal tract. [ 3 ] Many published literatures have demonstrated the advantages of this procedure such as shorter hospital stay and quicker recovery. [ 4 ] With regards to oncologic outcomes, there was no definite conclusion.…”