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Distal Pancreatectomy with Celiac Axis Resection Combined with Reconstruction of the Left Gastric Artery

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Distal pancreatectomy with celiac axis resection is one of the most aggressive approaches for the treatment of locally advanced pancreatic cancer with common hepatic artery and/or celiac axis invasion. However, ischemic complications such as ischemic gastropathy and liver failure are problematic. To avoid these complications, we developed left gastric artery-reconstructing distal pancreatectomy with celiac axis resection. We used the middle colic artery for reconstruction. We performed this procedure in 10 patients, using the middle colic artery in three different ways: left branch reconstruction, right branch reconstruction, and reverse reconstruction. On postoperative images, 90% of the reconstructed left gastric arteries were patent. No complications associated with arterial reconstruction occurred. No patients developed ischemic gastropathy or liver failure. The R0 resection rate was 70%. Nine patients underwent adjuvant chemotherapy and seven patients were able to start it within 90 days. Distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery using the middle colic artery is a feasible option and would enhance the safety for carefully selected patients. Multicenter validation is needed to clarify the benefits of this new procedure.

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Acknowledgements

Authors’ Contributions

Study conception and design: Sato, Inoue, Takahashi, Ishizawa, Mise, Saiura

Acquisition of data: Sato, Inoue

Analysis and interpretation of data: Sato, Inoue, Ito, Saiura

Drafting of manuscript: Sato, Inoue, Saiura

Critical revision: Takahashi, Ishizawa, Mise, Ito

Final approval: Sato, Inoue, Takahashi, Ishizawa, Mise, Ito, Saiura

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Takafumi Sato, Yosuke Inoue, Yu Takahashi, Yoshihiro Mise, Takeaki Ishizawa, Hiromichi Ito & Akio Saiura

  2. Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Kenta Tanakura

Authors
  1. Takafumi Sato
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  2. Yosuke Inoue
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  3. Yu Takahashi
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  4. Yoshihiro Mise
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  5. Takeaki Ishizawa
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  6. Kenta Tanakura
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  7. Hiromichi Ito
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  8. Akio Saiura
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Correspondence to Akio Saiura.

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Sato, T., Inoue, Y., Takahashi, Y. et al. Distal Pancreatectomy with Celiac Axis Resection Combined with Reconstruction of the Left Gastric Artery. J Gastrointest Surg 21, 910–917 (2017). https://doi.org/10.1007/s11605-017-3366-5

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  • DOI: https://doi.org/10.1007/s11605-017-3366-5

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