据报道，既往癌症患者中第二次新发胰腺导管腺癌 (PDAC) 的发生率为 6%。1,2 然而，随着全身治疗的改进，生存率增加，既往 PDAC 后再次发生 PDAC 的发生率3-8 在这种情况下，详细介绍了在接受胰十二指肠切除术治疗的先前 PDAC 后进行第二次从头 PDAC 的全胰腺切除术的结构化和逐步方法。我们介绍了两个类似的病例。第一位患者是一名 71 岁女性，患有新发身体 PDAC，第二名患者是一位 5​​0 岁女性，患有新发尾部 PDAC。为了排除复发，采用了免疫组织化学染色以及由两名经验丰富的病理学家对活检进行审查。两名患者均在 4 年前和 3 年前因 PDAC 接受了腹腔镜胰十二指肠切除术。每位患者接受了四个周期的新辅助化疗，并接受了安全的腹腔镜全胰腺切除术。手术前，进行三维解剖和端口部位建模，以优化对肿瘤、血管和邻近器官之间空间关系的理解。端口部位建模（包括气腹模拟）侧重于从门静脉解剖胆胰肢体的最佳端口设置。胆胰肢体完全动员后，胆胰肢体在肝空肠吻合术和胰空肠吻合术之间进行缝合。必须非常小心，以避免意外钉伤肝动脉或腹腔干。其余的解剖类似于标准的远端胰脾切除术。虚拟胰腺切除术模型有助于为该病例的关键步骤（即门静脉胰空肠吻合术的解剖）提供最佳设置。肝胰空肠吻合术和胰胰空肠吻合术之间的胆胰肢体的早期分割对于促进剩余的解剖至关重要。随着既往患有 PDAC 的患者的生存率随着时间的推移而改善，腹腔镜胰十二指肠切除术后进行腹腔镜全胰腺切除术进行从头 PDAC 可能会变得更加常见。© 2024。外科肿瘤学会。

The incidence of a second de novo pancreatic ductal adenocarcinoma (PDAC) among patients with prior cancer has been reported to be 6%.1,2 however, as survival increases through improvements in systemic therapy, this incidence of a de novo PDAC after prior PDAC may become more prevalent.3-8 In this context, a structured and stepwise approach to a total pancreatectomy for a second de novo PDAC after a prior PDAC treated with a pancreaticoduodenectomy is detailed.We present two similar cases. The first patient was a 71-year-old female with de novo body PDAC, and the second was a 50-year-old female with de novo tail PDAC. To rule out recurrence, immunohistochemical staining as well as the review of biopsies by two experienced pathologists were employed. Both patients had undergone a laparoscopic pancreatoduodenectomy for PDAC 4 and 3 years prior. Each patient received four cycles of neoadjuvant chemotherapy and underwent a safe laparoscopic total pancreatectomy.Prior to surgery, three-dimensional anatomic and port site modeling is performed to optimize the understanding of the spatial relationship between the tumor, blood vessels, and adjacent organs involved. The port site modeling (including pneumoperitoneum simulation) focuses on the optimal port set-up for dissecting the biliopancreatic limb off the portal vein. Following complete mobilization of the biliopancreatic limb, the biliopancreatic limb is staple-divided between the hepatico- and pancreaticojejunostomy. Great care must be taken to avoid accidental staple injury to the hepatic artery or celiac trunk. The remainder of the dissection is akin to a standard distal pancreaticosplenectomy.Virtual pancreatectomy modeling facilitates an optimal set-up for the critical step of this case, i.e. dissection of the pancreaticojejunostomy off the portal vein. Early division of the biliopancreatic limb between hepatico- and pancreatojejunostomy is crucial to facilitating the remainder of the dissection. Laparoscopic total pancreatectomy for a de novo PDAC after laparoscopic pancreaticoduodenectomy may become more common as survival of patients with prior PDAC improves over time.© 2024. Society of Surgical Oncology.