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Hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy in advanced pancreatic cancer

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Abstract

Purpose

Surgical resection is the only curative treatment for pancreatic cancer. Arterial resection and reconstruction during pancreaticoduodenectomy for advanced pancreatic cancer remain controversial due to a high rate of complications.

Methods

We report two cases of pancreatic cancer with hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy after neoadjuvant therapy.

Results

The patients underwent pancreaticoduodenectomy with resection of the right hepatic and common hepatic arteries. Achieving direct anastomosis was difficult; therefore, we planned hepatic artery reconstruction using the right gastroepiploic artery. We performed the reconstruction using an interrupted suture with end-to-end anastomosis. The first patient developed a postoperative pancreatic fistula, while the postoperative course of the second patient was uneventful. However, there were no adverse events related to the arterial reconstruction. R0 resection was achieved, and postoperative computed tomography revealed good patency of the reconstructed artery.

Conclusion

Hepatic artery reconstruction using the right gastroepiploic artery in pancreatic cancer might be technically safe and might become one of the alternative options.

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Acknowledgements

We would like to thank Tatsuya Ioka for the useful discussions.

Author information

Authors and Affiliations

  1. Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan

    Yoshitaro Shindo, Yukio Tokumitsu, Satoshi Matsukuma, Hiroto Matsui, Masao Nakajima, Nobuaki Suzuki, Shigeru Takeda & Hiroaki Nagano

  2. Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube, Yamaguchi, 755-8505, Japan

    Yoshinobu Hoshii

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  1. Yoshitaro Shindo
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Contributions

YS, YT, SM, ST, and HN participated in the study conception and design. YS, HM, and YH participated in the acquisition of data. YS, MN, NS, and YH participated in the analysis and interpretation of the data. YS, SM, and HM participated in the drafting of the manuscript. YS, YT, SM, HM, MN, NS, ST, YH, and HN participated in the critical revision of the manuscript.

Corresponding author

Correspondence to Hiroaki Nagano.

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Ethics declarations

The study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Review Boards of Yamaguchi University Hospital (number H2020-012). Written informed consent was obtained from all patients in this study.

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The authors declare no competing interests.

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Shindo, Y., Tokumitsu, Y., Matsukuma, S. et al. Hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy in advanced pancreatic cancer. Langenbecks Arch Surg 406, 2075–2080 (2021). https://doi.org/10.1007/s00423-021-02120-0

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