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Transfusion free radical antegrade modular pancreaticosplenectomy of metastatic neuroendocrine tumor of the pancreas in Jehovah's Witness patient.

Jeon YB, Yun S, Choi D - Ann Surg Treat Res (2015)

Bottom Line: We present a case of successful bloodless multimodality therapy, which was performed for a JW.Multimodality therapy is very important for optimal treatment of PNET.Along with intimate interdepartmental cooperation, careful patient selection and appropriate perioperative management could possibly enhance the surgical outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea.

ABSTRACT
In a popular sense, Jehovah's Witnesses (JW) have their creeds, one of which is refusal of blood transfusion. Such refusal may impinge on their proper management, especially in critical situations. We present a case of successful bloodless multimodality therapy, which was performed for a JW. The patient was a 49-year-old woman and JW who had general weakness 7 days before admission. She was diagnosed with a pancreatic neuroendocrine tumor (PNET) with hepatic metastases. Transcatheter arterial chemoembolization and Sandostatin LAR injection were performed, and then she was given a transfusion-free Radical antegrade modular pancreatosplenectomy sequentially. We gave recombinant human erythropoietin and iron hydroxide sucrose complex daily for five days after surgery. She was discharged at postoperative day 12 without any surgical complications. Multimodality therapy is very important for optimal treatment of PNET. Along with intimate interdepartmental cooperation, careful patient selection and appropriate perioperative management could possibly enhance the surgical outcome.

No MeSH data available.


Related in: MedlinePlus

Surgical dissection plan for radical antegrade modular pancreaticosplenectomy. A, left adrenal gland; C, colon; K, left kidney; P, pancreas; S, spleen.
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Figure 2: Surgical dissection plan for radical antegrade modular pancreaticosplenectomy. A, left adrenal gland; C, colon; K, left kidney; P, pancreas; S, spleen.

Mentions: The attending surgeon and anesthesiologist discussed the risks of bloodless major operations. The patient signed a consent form for the operation without the use of blood products. She allowed albumin and acute normovolemic hemodilution (ANH). Considering that it was a cancer surgery, Cell Saver was not allowed due to risk of shed cancer cells. The preoperative albumin level was 3.7 g/dL, hemoglobin was 12.6 mg/dL, and hematocrit was 36.8%. The dissection of RAMPS procedure started from the left side, which is the neck of the pancreas, to the right side with splenic vessels and celiac node dissection. Afterwards, the plane of dissection proceeded posteriorly in a sagittal plane along the celiac artery and the superior mesenteric artery down to the level of the aorta, in sequence, going on laterally to the left adrenal gland (Fig. 2). There was severe adhesion of omentum to the hepatic tumors and pancreatic tumor, however, the celiac trunk and the superior mesenteric artery were relatively well isolated from the tumor. The pancreatic tumor was well vascularized, capsulated, and abutted to the renal arteries and veins, but not invading (Fig. 3A-C). Histological diagnosis was consistent with well-differentiated pancreatic neuroendocrine carcinoma with negative resection margin but extending to the peripancreatic soft tissue and splenic venous wall. It showed angioinvasion and neural invasion containing ischemic necrosis. Immunohistochemical examination revealed that chromogranin A, CD56, CD10, and CK were positive (Fig. 3D-G). Pathologic staging was T3N0M1 stage IV according to American Joint Committee on Cancer/Union for International Cancer Control TNM staging for pancreatic tumors.


Transfusion free radical antegrade modular pancreaticosplenectomy of metastatic neuroendocrine tumor of the pancreas in Jehovah's Witness patient.

Jeon YB, Yun S, Choi D - Ann Surg Treat Res (2015)

Surgical dissection plan for radical antegrade modular pancreaticosplenectomy. A, left adrenal gland; C, colon; K, left kidney; P, pancreas; S, spleen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325654&req=5

Figure 2: Surgical dissection plan for radical antegrade modular pancreaticosplenectomy. A, left adrenal gland; C, colon; K, left kidney; P, pancreas; S, spleen.
Mentions: The attending surgeon and anesthesiologist discussed the risks of bloodless major operations. The patient signed a consent form for the operation without the use of blood products. She allowed albumin and acute normovolemic hemodilution (ANH). Considering that it was a cancer surgery, Cell Saver was not allowed due to risk of shed cancer cells. The preoperative albumin level was 3.7 g/dL, hemoglobin was 12.6 mg/dL, and hematocrit was 36.8%. The dissection of RAMPS procedure started from the left side, which is the neck of the pancreas, to the right side with splenic vessels and celiac node dissection. Afterwards, the plane of dissection proceeded posteriorly in a sagittal plane along the celiac artery and the superior mesenteric artery down to the level of the aorta, in sequence, going on laterally to the left adrenal gland (Fig. 2). There was severe adhesion of omentum to the hepatic tumors and pancreatic tumor, however, the celiac trunk and the superior mesenteric artery were relatively well isolated from the tumor. The pancreatic tumor was well vascularized, capsulated, and abutted to the renal arteries and veins, but not invading (Fig. 3A-C). Histological diagnosis was consistent with well-differentiated pancreatic neuroendocrine carcinoma with negative resection margin but extending to the peripancreatic soft tissue and splenic venous wall. It showed angioinvasion and neural invasion containing ischemic necrosis. Immunohistochemical examination revealed that chromogranin A, CD56, CD10, and CK were positive (Fig. 3D-G). Pathologic staging was T3N0M1 stage IV according to American Joint Committee on Cancer/Union for International Cancer Control TNM staging for pancreatic tumors.

Bottom Line: We present a case of successful bloodless multimodality therapy, which was performed for a JW.Multimodality therapy is very important for optimal treatment of PNET.Along with intimate interdepartmental cooperation, careful patient selection and appropriate perioperative management could possibly enhance the surgical outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea.

ABSTRACT
In a popular sense, Jehovah's Witnesses (JW) have their creeds, one of which is refusal of blood transfusion. Such refusal may impinge on their proper management, especially in critical situations. We present a case of successful bloodless multimodality therapy, which was performed for a JW. The patient was a 49-year-old woman and JW who had general weakness 7 days before admission. She was diagnosed with a pancreatic neuroendocrine tumor (PNET) with hepatic metastases. Transcatheter arterial chemoembolization and Sandostatin LAR injection were performed, and then she was given a transfusion-free Radical antegrade modular pancreatosplenectomy sequentially. We gave recombinant human erythropoietin and iron hydroxide sucrose complex daily for five days after surgery. She was discharged at postoperative day 12 without any surgical complications. Multimodality therapy is very important for optimal treatment of PNET. Along with intimate interdepartmental cooperation, careful patient selection and appropriate perioperative management could possibly enhance the surgical outcome.

No MeSH data available.


Related in: MedlinePlus