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Indications and Pitfalls of the Modified Distal Pancreatectomy with Celiac Axis En Bloc Resection for Pancreatic Cancer

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Innovation of Diagnosis and Treatment for Pancreatic Cancer

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Abstract

Most pancreatic adenocarcinomas recur systemically. Where a tumor involves arterial structures, rapid recurrence occurs even after radical resection. Therefore, surgeons should always take tumor biology, chemotherapy, and safety of the surgery into consideration. An R0 resection is not the primary healing issue for borderline resectable pancreatic adenocarcinoma. Using safer modification of the Appleby operation and with the emergence of the borderline resectable pancreatic carcinoma concept, this procedure attracts the attention of pancreatic surgeons as a radical pancreatectomy for borderline resectable pancreatic body/tail carcinoma. The advantages of distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) are its ability to take a wide surgical margin in pancreatic body/tail carcinoma and to relieve cancer pain caused by celiac axis en-bloc resection combined with removal of the tumor infiltrating plexuses. DP-CAR is feasible and safe compared with standard distal pancreatectomy provided if the surgeon pays attention to several pitfalls which could lead to fatal complication. The value of DP-CAR in pancreatic body/tail carcinoma is becoming evident, especially in the initial 2 years after surgery. Given its benefits, DP-CAR should be more widely considered as opposed to the common practice of administering stronger regimen of chemotherapy for pancreatic carcinoma. This procedure may be justifiable in selected patients owing to the potential survival benefit in sophisticated institutions. Modified DP-CAR, synonymous with DP-CAR that preserves the left gastric artery, is an option for selected cases based on the anatomical tumor position and arterial features.

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  1. Second Department of Surgery, Wakayama Medical University, Kimiidera, Wakayama, 641-8510, Japan

    Ken-ichi Okada & Hiroki Yamaue

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  1. Ken-ichi Okada
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  2. Hiroki Yamaue
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Correspondence to Hiroki Yamaue .

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  1. Second Department of Surgery, Wakyama Medical University, Wakayama, Japan

    Hiroki Yamaue

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Okada, Ki., Yamaue, H. (2017). Indications and Pitfalls of the Modified Distal Pancreatectomy with Celiac Axis En Bloc Resection for Pancreatic Cancer. In: Yamaue, H. (eds) Innovation of Diagnosis and Treatment for Pancreatic Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-2486-3_14

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  • DOI: https://doi.org/10.1007/978-981-10-2486-3_14

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