Margin-negative minimally invasive pancreatoduodenectomy following FOLFIRINOX neoadjuvant chemotherapy in invasive intraductal papillary mucinous neoplasm of pancreas: a case report

Abstract

This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous neoplasm (IPMN), for which curative margin-negative resection initially seemed challenging. Five cycles of the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) were administered preoperatively, resulting in a significant reduction of the intraductal mass size and deformity of the main vessels. The patient subsequently underwent a successful robotic pylorus-preserving pancreatoduodenectomy. Postoperatively, the patient received adjuvant chemotherapy with FOLFIRINOX, and after 5 months, showed no signs of tumor recurrence or specific complications. These findings suggest that neoadjuvant therapy can be a potentially effective strategy even in advanced invasive IPMN. Further research is necessary to establish guidelines for its application.

Keywords: Minimally invasive surgery; Neoadjuvant chemotherapy; Pancreatic intraductal neoplasms; Pancreatoduodenectomy.

Fig. 1

Preoperative computed tomography (CT) scans. Deformity of junction between pancreatic luminal mass and portal vein at initial CT (A), dilated pancreatic duct at initial CT (B), and the preoperative CT images at the corresponding same levels (C, D).

Fig. 2

Operative finding. Origin of SA, CHA, and SMV-SV-PV confluence are noted after removal of pancreatoduodenal unit (stapler line: white arrows). PV, SMV, SV are clearly reserved. CHA, common hepatic artery; PV, portal vein; SA, splenic artery; SV, splenic vein; SMV, superior mesenteric vein; SMA, superior mesenteric artery.