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

Figure 1 Flowchart for multimodal treatment of borderline/locally advanced pancreatic neck-body cancer. MDT: Multidisciplinary team; SMV: Superior mesenteric vein; PV: Portal vein.

Figure 2 The definition of pancreatic subdivisions. A: The pancreatic subdivisions were defined as follows: Pancreatic head, right to the portal vein (PV)/superior mesenteric vein (SMV); pancreatic neck, in front of the PV/SMV; pancreatic body, left of the PV/SMV to left of the abdominal aorta; pancreatic tail, left of the abdominal aorta; B: Pancreatic cancer involving the neck and body of the pancreas; pancreatic cancer (yellow arrow), portal vein (blue arrow). PV: Portal vein; GDA: Global domain adaptation; CBD: Common bile duct; SMV: Superior mesenteric vein; Ph: Pancreatic head; Pn: Pancreatic neck; Pb: Pancreatic body; Pt: Pancreatic tail; CHA: Common hepatic artery; CA: Celiac artery; LGA: Left gastric artery; SA: Spleen artery; AA: Abdominal aorta; SMA: Superior mesenteric artery.

Figure 3 Changes in pancreatic lesions before and after neoadjuvant therapy. A and B: Case 1; C and D: Case 2. Yellow arrows indicate the lesions.

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.