Details and Outcomes of Distal Pancreatectomy with Celiac Axis Resection Preserving the Left Gastric Arterial Flow.

Abstract

BACKGROUND:

To describe the technical details and efficacy of distal pancreatectomy with celiac axis resection (DP-CAR) and left gastric artery (LGA) flow preservation for pancreatic ductal adenocarcinoma (PDAC).

METHOD:

This single-center, retrospective analysis investigated short- and long-term outcomes of DP-CAR performed on 55 patients with PDAC from 2011 to 2019. Our method included LGA reconstruction after total resection of the CA (rDP-CAR group; 24 patients) or LGA preservation if the tumor invasion was away from its root (pDP-CAR group; 31 patients), a CA-first approach to reduce blood loss during dissection, and conservative drain management with or without jejunal serosal patching at the pancreatic stump.

RESULTS:

Among the study patients, 23 had locally advanced PDAC and 22 had borderline resectable PDAC. Median operation duration was 443 min (248-810), estimated blood loss was 600 mL (150-2280), and incidence of transfusion was 2%. Ischemic complications occurred exclusively in the rDP-CAR group, including two patients with ischemic gastropathy (8%) and three patients with findings of liver ischemia on computed tomography (13%). One patient underwent relaparotomy for stomach perforations, and 19 patients (35%) had pancreatic fistula, including 8 patients who underwent conservative drain placement for more than 3 weeks without specific symptoms. There were no Clavien-Dindo grade 4 or higher postoperative complications. Preoperative therapy showed improved 3-year overall survival rates than without (54% vs. 37%, p = 0.027).

CONCLUSIONS:

Using the standardized technique, DP-CAR was safely performed with no mortality and acceptable long-term survival.

• Authors: Yosuke Inoue, Akio Saiura, Takafumi Sato, Atsushi Oba, Yoshihiro Ono, Yoshihiro Mise, Hiromichi Ito, Yu Takahashi
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 28 Issue 13 Pg. 8283-8294 (Dec 2021) ISSN: 1534-4681 [Electronic] United States
• PMID: 34143337 (Publication Type: Journal Article)
• Copyright: © 2021. Society of Surgical Oncology.

Topics

• Celiac Artery (diagnostic imaging, surgery)
• Humans
• Pancreatectomy
• Pancreatic Neoplasms (surgery)
• Retrospective Studies
• Stomach (surgery)