Combined resection of the gastroduodenal artery without revascularization in distal pancreatectomy with en bloc celiac axis resection (extended DP-CAR) for pancreatic cancer: A case report. (January 2023)

• Record Type: Journal Article
• Authors: Tomioka, Atsushi; Asakuma, Mitsuhiro; Kawaguchi, Nao; Komeda, Koji; Shimizu, Tetsunosuke; Lee, Sang-Woong
• Is Part Of: International journal of surgery case reports. Volume 102(2023)
• Publication Date: 2023-01
• Subjects: CA celiac axis -- CHA common hepatic artery -- CT computed tomography -- DP-CAR distal pancreatectomy with en bloc celiac axis resection -- GDA gastroduodenal artery -- IMV inferior mesenteric vein -- ISGPF International Study Group of Pancreatic Fistula -- LAPC locally advanced pancreatic cancer -- LGA left gastric artery -- NCCN The National Comprehensive Cancer Network -- PHA proper hepatic artery -- PV portal vein -- r-RHA replaced right hepatic artery -- r-LHA replaced left hepatic artery -- SMA superior mesenteric artery -- SMV superior mesenteric vein -- SpA splenic artery -- UICC The Union for International Cancer Control; Case report -- Extended DP-CAR -- DP-CAR -- Locally advanced pancreatic cancer -- Gastroduodenal artery; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107803
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) is performed to remove locally advanced pancreatic cancer (LAPC) that involves the celiac axis (CA), the common hepatic artery (CHA), or the root of the splenic artery (SpA). It is not usually applied to LAPC involving both the CA and the gastroduodenal artery (GDA) because transection of the GDA cannot assure hepatic perfusion. Preserving the replaced hepatic artery might allow combined resection of the GDA without revascularization. Presentation of case: A 78-year-old woman who was diagnosed with LAPC of the pancreatic head and body that invaded the GDA and proper hepatic artery, as well as the CA. The left hepatic artery (LHA) was solitarily branched from the left gastric artery (LGA), which was branched from proximal to the confluence of the CHA and the SpA. The root of the LGA was intact. We successfully performed DP-CAR with combined resection of the GDA, without revascularization, by preserving the LGA. Discussion: This is the first English literature case of extended DP-CAR with preservation of the replaced LHA (r-LHA). Aberrant right and left hepatic arteries are common variations. Checking the arterial variations is very important when deciding the treatment strategy for LAPC, especially in cases that appear unresectable. Conclusion: Our case indicated that the r-LHA alone can supply the entire liver in extended DP-CAR. The resectability must be decided with close evaluations of the vessel variations and the tumor status. Highlights: Locally advanced pancreatic cancer involving celiac axis and gastroduodenal artery DP-CAR with combined resection of gastroduodenal artery without revascularization First English literature case of extended DP-CAR with replaced LHA preserved Significance of arterial variations when deciding the treatment strategy