[Devising a Surgical Approach Using the Intestinal Derotation Procedure for Locally Advanced Pancreatic Cancer]

A 77-year-old man was diagnosed pancreatic head cancer(cT4cN0cM0, cStage Ⅲ)with a contrasting-enhanced CT scan showing soft-tissue shadow in contact with the SMA less than 180 degrees and extensive invasion of the SMV. After neoadjuvant chemotherapy(GnP was selected due to the possibility of unresectability), subtotal stomach-preserving pancreaticoduodenectomy( SSPPD)with resection and reconstruction portal vein was performed. Intestinal derotation procedure in combination with surgery, and there was no evidence of SMA invasion, and J2A, which was also suspected to be invaded on preoperative imaging, could be preserved. The complicated portal vein reconstruction(long reconstruction distance requiring grafting and reanastomosis of J1V+J2V to J3V+ICV)could be performed in a joint operation with cardiovascular surgery. The pathological results of the excised specimen showed that ypT3, ypN1a, M0, ypStage ⅡB, and R0 surgery were feasible, and the patient was discharged on the 19th day after surgery without any postoperative complications. The surgical approach using the intestinal derotation procedure and joint surgery with other departments were useful in safely performing surgery for highly locally advanced pancreatic cancer.