Radical Mesopancreas Resection in Obese Patient During Laparoscopic Pancreaticoduodenectomy

Abstract

Introduction:

Laparoscopic pancreaticoduodenectomy (LPD) for cancer is currently considered a valid alternative to the open approach. ^{1 –8} Obesity represents a major technical issue for LPD and can be associated with an increased risk of bleeding, conversion, and postoperative pancreatic leak. ^{9 –12} Moreover, achieving a radical en bloc resection of the mesopancreas in such patients is complex as the superior mesenteric artery (SMA) is embedded in fatty tissue. This video presents a surgical technique to achieve a radical en bloc resection of the mesopancreas in the setting of obesity. ^{2,9 –12}

Methods:

A 68-year-old woman with persistent fatigue and weight loss underwent a computed tomography scan, showing a 2 cm mass within the pancreatic head without superior mesenteric vein or SMA involvement. There was a suggestion of mesopancreas infiltration on both sides of the SMA. The patient's body mass index at the time of the diagnosis was 39 kg/m² (100 kg/1.60 m). The biopsy, performed at the time of endoscopic retrograde cholangiopancreatography, showed a well-differentiated adenocarcinoma of the pancreas. The carbohydrate antigen 19–9 was 21 UI/mL (normal value <37 UI/mL). The patient was classified as resectable. A radical LPD with en bloc mesopancreas resection was performed.

Results:

Operative time was 6 h and 20 min, blood loss was 120 mL. Frozen sections of the pancreatic margin, of the bile duct margin, as well as the SMA margins (mesopancreas margins) were all negative for tumor infiltration. The patient developed a postoperative grade A pancreatic leak that healed spontaneously by postoperative day 10 and the hospital length of stay was 14 days. Histopathologic examination showed a well-differentiated adenocarcinoma of the pancreas ypT3 N1 (2/32) R0.

Conclusion:

LPD for cancer with radical mesopancreas resection can be achieved in obese patients. A large experience in open and laparoscopic pancreatic surgery is mandatory before embarking on LPD for obese patients.

No competing financial interests exist.

Runtime of video: 9 mins 57 secs