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Robot-assisted combined pancreatectomy/hepatectomy for metastatic pancreatic acinar cell carcinoma: case report and review of the literature

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Abstract

Acinar cell carcinoma (ACC) of the pancreas is a rare neoplasm with less aggressive behavior than ductal carcinoma. As a result, surgical resection for metastatic ACC is a therapeutic option which can result in long-term survival. There is a paucity of data describing institutional approaches to these challenging patients, and therefore, we herein describe our institution’s approach to a patient with a distal pancreatic ACC and isolated liver metastasis. The patient underwent neoadjuvant chemotherapy (FOLFIRINOX), followed by a robot-assisted distal pancreatectomy/splenectomy and non-anatomic segment 6 resection. He was discharged to home post-operative day 2. Final pathology revealed complete tumor response of the liver metastasis and a margin negative resection of the primary tumor. He remains disease free and without complications at 3 months. We highlight that combined modality therapy for metastatic ACC can yield long-term survival in selected patients. Similarly, the robotic platform enables performance of complex multivisceral resections with rapid recovery. Future research investigating precision medicine for metastatic ACC is warranted given widely variable tumor biology in this disease.

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Acknowledgements

We would like to thank the patient, who allowed us to care for him and gave informed consent to share his story for the education of the medical community. We would also like to thank Dr. Azumi (Department of Pathology, Medstar Georgetown University Hospital) for providing histologic slides from the case.

Funding

No funding was used in the performance or description of this work.

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Authors and Affiliations

  1. Department of General Surgery, MedStar-Georgetown University Hospital, Washington, DC, USA

    Anthony Michael Villano & Dany Barrak

  2. Howard University School of Medicine, Washington, DC, USA

    Anish Jain

  3. MedStar Georgetown Transplant Institute, MedStar-Georgetown University Hospital, 3800 Reservoir Rd., NW, PHC Building, 2nd Floor, Washington, DC, 20007, USA

    Erin Meslar, Pejman Radkani, Emily Winslow, Thomas Fishbein & Jason Hawksworth

  4. Department of Gastroenterology, MedStar-Georgetown University Hospital, Washington, DC, USA

    Walid Chalhoub & Nadim Haddad

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  1. Anthony Michael Villano
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Correspondence to Jason Hawksworth.

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Conflict of interest

Dr. Anthony Villano, Dr. Dany Barrak, Anish Jain, Dr. Pejman Radkani, Dr. Walid Chalhoub, Dr. Nadim Haddad, Dr. Emily Winslow, Dr. Thomas Fishbein, Dr. Jason Hawksworth, and Erin Meslar declare that they have no conflicts of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Villano, A.M., Barrak, D., Jain, A. et al. Robot-assisted combined pancreatectomy/hepatectomy for metastatic pancreatic acinar cell carcinoma: case report and review of the literature. Clin J Gastroenterol 13, 973–980 (2020). https://doi.org/10.1007/s12328-020-01146-z

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  • DOI: https://doi.org/10.1007/s12328-020-01146-z

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