Fluorescence Laparoscopic Local Resection of Pancreatic Head Tumor with End-to-End Pancreatic Anastomosis: A New Surgical Strategy for Pancreatic Head Tumor Resection

Abstract

Background: With the application of new technologies such as three-dimensional and fluorescent staining, laparoscopic surgery is more comprehensive, accurate, and safe.^1-3 For specific borderline or benign pancreatic head tumors that are small, well-differentiated, and have an intact capsule, laparoscopic local enucleation of the pancreatic head tumor is the preferred surgical approach;^4,5 however, when the tumor involves the pancreatic duct, it is often necessary to resect the pancreatic duct and reconstruct it. This paper introduces a local resection of the pancreatic head tumor with end-to-end anastomosis of the pancreatic duct under fluorescence laparoscopy. According to literature review, there are no reports regarding end-to-end anastomosis of the pancreatic head duct under laparoscopy. PATIENT AND METHODS: Using magnetic resonance imaging (MRI) examination, a 35-year-old female was found to have a solid pseudopapillary neoplasm in the pancreatic head sized 5.4 × 3.8 × 4.2 cm. We performed fluorescence laparoscopic local resection of the pancreatic head tumor. During the operation, the tumor involved the main pancreatic duct, and Takada's end-to-end anastomosis of the pancreatic duct was performed.

Results: The duration of the operation was 180 min and blood loss was 100 mL. The patient recovered smoothly and was discharged on the eighth day after operation. Postoperative pathology suggested a solid pseudopapillary neoplasm. There was no dilation of the pancreatic duct 3 months after surgery.

Conclusion: Laparoscopic local tumor enucleation has been widely accepted in the treatment of small, well-encapsulated, well-differentiated benign tumors of the pancreatic head. When the pancreatic head tumor involves the main pancreatic duct, Takada's end-to-end anastomosis of the pancreatic duct provides a new surgical strategy.