Yosuke Inoue1, Akio Saiura2,3, Takafumi Sato2, Atsushi Oba2, Yoshihiro Ono2, Yoshihiro Mise2,3, Hiromichi Ito2, Yu Takahashi2. 1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. yosuke.inoue@jfcr.or.jp. 2. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 3. Department of Hepatobiliary Pancreatic Surgery, Juntendo University Hospital, Tokyo, Japan.
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.
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: Lee M Ocuin; Jennifer L Miller-Ocuin; Stephanie M Novak; David L Bartlett; J Wallis Marsh; Allan Tsung; Kenneth K Lee; Melissa E Hogg; Herbert J Zeh; Amer H Zureikat Journal: HPB (Oxford) Date: 2016-07-08 Impact factor: 3.647
Authors: Emre F Yekebas; Dean Bogoevski; Guellue Cataldegirmen; Christina Kunze; Andreas Marx; Yogesh K Vashist; Paulus G Schurr; Lena Liebl; Sabrina Thieltges; Karim A Gawad; Claus Schneider; Jakob R Izbicki Journal: Ann Surg Date: 2008-02 Impact factor: 12.969
Authors: Sjors Klompmaker; Niek A Peters; Jony van Hilst; Claudio Bassi; Ugo Boggi; Olivier R Busch; Willem Niesen; Thomas M Van Gulik; Ammar A Javed; Jorg Kleeff; Manabu Kawai; Mickael Lesurtel; Carlo Lombardo; A James Moser; Ken-Ichi Okada; Irinel Popescu; Raj Prasad; Roberto Salvia; Alain Sauvanet; Christian Sturesson; Matthew J Weiss; Herbert J Zeh; Amer H Zureikat; Hiroki Yamaue; Christopher L Wolfgang; Melissa E Hogg; Marc G Besselink Journal: Ann Surg Oncol Date: 2019-01-04 Impact factor: 5.344