Abstract
Purpose
Locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) involving the celiac artery (CeA), the common hepatic artery and the gastroduodenal artery (GDA) is considered unresectable. We developed the novel procedure of pancreaticoduodenectomy with celiac artery resection (PD-CAR) for such LA-PDACs.
Methods
From 2015 to 2018, we performed curative pancreatectomy with major arterial resection for 13 LA-PDACs as a clinical study (UMIN000029501). Of those, four patients with pancreatic neck cancer involving the CeA and GDA were candidates for PD-CAR. Prior to surgery, blood flow alterations were performed to unify the blood flow to the liver, stomach, and pancreas, resulting in feeding from the cancer-free artery. During PD-CAR, arterial reconstruction of the unified artery was performed as needed. Based on the records of PD-CAR cases, we retrospectively analyzed the validity of the operation.
Results
R0 resection was achieved in all patients. Arterial reconstruction was performed in three patients. In another patient, the hepatic arterial flow was maintained by preserving of the left gastric artery. The mean operative time was 669 min, and the mean blood loss was 1003 ml. Although Clavien-Dindo classification III-IV postoperative morbidities occurred in three patients, no reoperations nor mortalities occurred. Although two patients died of cancer recurrence, one patient survived for 26 months without recurrence (died of cerebral infarction), and another is alive at 76 months without recurrence.
Conclusion
PD-CAR, which enabled R0 resection and preservation of the residual stomach, pancreas, and spleen, provided acceptable postoperative outcomes.
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Abbreviations
- PD-CAR:
-
Pancreaticoduodenectomy with celiac artery resection
- LA-PDAC:
-
Locally advanced pancreatic ductal adenocarcinoma
- IVR:
-
Interventional radiology
- CeA:
-
Celiac artery
- GDA :
-
Gastroduodenal artery
- RHA:
-
Right hepatic artery
- J2A:
-
Second jejunal artery
- DP-CAR:
-
Distal pancreatectomy with celiac artery resection
- CHA:
-
Common hepatic artery,;
- TP-CAR:
-
Total pancreatectomy with celiac artery resection including hepatic artery reconstruction
- HA:
-
Hepatic artery
- QoL:
-
Quality of life
- PDAC :
-
Pancreatic ductal adenocarcinoma
- SMA:
-
Superior mesenteric artery
- SMV:
-
Superior mesenteric vein
- PV:
-
Portal vein
- RHA :
-
Right hepatic artery
- SpA:
-
Splenic artery
- LGA:
-
Left gastric artery
- RGEA:
-
Right gastroepiploic artery
- rRHA:
-
Replaced from the SMA
- PHA:
-
Proper hepatic artery
- J1A:
-
First jejunal artery
- RGA:
-
Right gastric artery
- ICG:
-
Indocyanine green
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Study conception and design. K.K, Acquisition of data. K.K, R.A, Analysis and interpretation of data. J.T, K.N, G.O, H.S, Drafting of manuscript. S.T, T.I, Critical revision of manuscript. H.M, A,Y
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Kimura, K., Amano, R., Tauchi, J. et al. Pancreaticoduodenectomy with celiac artery resection (PD-CAR) for unresctable locally advanced pancreatic ductal adenocarcinoma. Langenbecks Arch Surg 408, 174 (2023). https://doi.org/10.1007/s00423-023-02860-1
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DOI: https://doi.org/10.1007/s00423-023-02860-1