Journal of Gastrointestinal Surgery

, Volume 21, Issue 5, pp 910–917 | Cite as

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

  • Takafumi Sato
  • Yosuke Inoue
  • Yu Takahashi
  • Yoshihiro Mise
  • Takeaki Ishizawa
  • Kenta Tanakura
  • Hiromichi Ito
  • Akio Saiura
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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.

Keywords

Pancreatic ductal adenocarcinoma Distal pancreatectomy with celiac axis resection Ischemic gastropathy Left gastric artery Arterial reconstruction 
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Notes

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

Compliance with Ethical Standards

None of the authors received any grant support.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Takafumi Sato
    • 1
  • Yosuke Inoue
    • 1
  • Yu Takahashi
    • 1
  • Yoshihiro Mise
    • 1
  • Takeaki Ishizawa
    • 1
  • Kenta Tanakura
    • 2
  • Hiromichi Ito
    • 1
  • Akio Saiura
    • 1
  1. 1.Department of Hepato-Biliary-Pancreatic SurgeryCancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan
  2. 2.Plastic and Reconstructive SurgeryCancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan

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