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CardioVascular and Interventional Radiology

, Volume 34, Issue 5, pp 1058–1064 | Cite as

Distal Pancreatectomy With En Bloc Resection of the Celiac Trunk for Extended Pancreatic Tumor Disease: An Interdisciplinary Approach

  • Timm Denecke
  • Andreas Andreou
  • Petr Podrabsky
  • Christian Grieser
  • Peter Warnick
  • Marcus Bahra
  • Fritz Klein
  • Bernd Hamm
  • Peter Neuhaus
  • Matthias Glanemann
Technical Note

Abstract

Purpose

Infiltration of the celiac trunk by adenocarcinoma of the pancreatic body has been considered a contraindication for surgical treatment, thus resulting in a very poor prognosis. The concept of distal pancreatectomy with resection of the celiac trunk offers a curative treatment option but implies the risk of relevant hepatic or gastric ischemia. We describe initial experiences in a small series of patients with left celiacopancreatectomy with or without angiographic preconditioning of arterial blood flow to the stomach and the liver.

Materials and Methods

Between January 2007 and October 2009, six patients underwent simultaneous resection of the celiac trunk for adenocarcinoma of the pancreatic body involving the celiac axis. In four of these cases, angiographic occlusion of the celiac trunk before surgery was performed to enhance collateral flow from the gastroduodenal artery. Radiologic and surgical procedures, findings, and outcome were analyzed retrospectively.

Results

Complete tumor removal (R0) succeeded in two patients, whereas four patients underwent R1-tumor resection. After surgery, one of the two patients without angiographic preparation experienced an ischemic stomach perforation 1 week after surgery. The other patient died from severe bleeding from an ischemic gastric ulcer. Of the four patients with celiac trunk embolization, none presented ischemic complications after surgery. Mean survival was 371 days.

Conclusion

In this small series, ischemic complications after celiacopancreatectomy occurred only in those patients who did not receive preoperative celiac trunk embolization.

Keywords

Pancreatic cancer Distal pancreatectomy Celiac trunk resection Angiography Embolization 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Timm Denecke
    • 1
  • Andreas Andreou
    • 2
  • Petr Podrabsky
    • 1
  • Christian Grieser
    • 1
  • Peter Warnick
    • 2
  • Marcus Bahra
    • 2
  • Fritz Klein
    • 2
  • Bernd Hamm
    • 1
  • Peter Neuhaus
    • 2
  • Matthias Glanemann
    • 2
  1. 1.Klinik für StrahlenheilkundeCharité—Universitätsmedizin BerlinBerlinGermany
  2. 2.Klinik für Allgemein-, Viszeral-, und TransplantationschirurgieCharité—Universitätsmedizin BerlinBerlinGermany

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