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Published on: February 2, 2022
Step-by-Step Pancreaticoduodenectomy in Complete Situs Inversus: Technical Strategy to Preserve Oncologic Principles
Alessia Fassari1, Bastien Le Floc'h2, Hector Prudhomme1
1Hepatobiliary and Digestive Surgery Department, University Hospital of Rennes, Rennes, France.
Annals of Surgical Oncology
|May 7, 2026
Summary
This study demonstrates that pancreaticoduodenectomy is feasible in patients with complete situs inversus, a rare mirrored anatomy condition. Meticulous planning and adaptation ensure safe and oncologically adequate resection for pancreatic cancer.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Imaging
Background:
- Complete situs inversus is a rare congenital condition with mirrored thoracoabdominal organs.
- Its association with pancreatic cancer is exceptionally rare and presents surgical challenges.
- This video illustrates surgical strategies for pancreaticoduodenectomy in situs inversus.
Purpose of the Study:
- To demonstrate the surgical strategy and technical adaptations for oncologic pancreaticoduodenectomy in a patient with complete situs inversus.
- To highlight the feasibility and safety of radical resection in rare anatomical variations.
Main Methods:
- A 68-year-old woman with situs inversus and pancreatic head adenocarcinoma underwent open pancreaticoduodenectomy.
- Preoperative imaging identified vascular variations; meticulous dissection and lymphadenectomy were performed.
- Reconstruction included pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy.
Main Results:
- Complete oncologic resection (R0) was achieved for the pancreatic adenocarcinoma.
- Postoperative course included Clavien-Dindo grade II events: chylous ascites and delayed gastric emptying.
- Final pathology revealed pT3N2 pancreatic adenocarcinoma with extensive lymph node involvement.
Conclusions:
- Pancreaticoduodenectomy is feasible and safe in patients with complete situs inversus and common mesentery.
- Meticulous preoperative planning and intraoperative adaptation to mirrored anatomy are crucial.
- Radical resection can be achieved even in rare anatomical conditions, maintaining surgical and oncological principles.
