Multimodal treatment combining neoadjuvant therapy, laparoscopic subtotal distal pancreatectomy and adjuvant therapy for pancreatic neck-body cancer: Case series

Figure 4 Laparoscopic subtotal pancreatectomy with portal vein/superior mesenteric vein reconstruction. A: The artery-first approach was applied in our laparoscopic subtotal pancreatectomy; B: Schematic diagram of the pancreas transection plane for laparoscopic subtotal pancreatectomy; C: We transected the pancreas along the left edge of the common bile duct during surgery; D: The involved portal vein was resected, rapid frozen section pathology confirmed no residual tumor cells at the portal vein transection margin; E: End-to-end anastomosis of the portal vein was performed, the soft tissues adjacent to the tumor in the Heidelberg triangle were removed; F: The posterior plane of resection was behind the left adrenal gland and Gerota’s fascia (similar to the posterior radical antegrade modular pancreatosplenectomy). SMA: Superior mesenteric artery; CBD: Common bile duct; CA: Celiac artery.