Abstract
Background
Locally advanced cancer of the pancreatic body involving the celiac and/or common hepatic arteries is often considered unresectable. Radical distal pancreatectomy with en bloc resection of these arteries without reconstruction was recently introduced to treat these tumors. However, experience is still limited. This study reviewed the safety and utility of the operation.
Patients and methods
We retrospectively studied the charts of 13 patients who underwent radical distal pancreatectomy.
Results
Unplanned arterial reconstruction was required in three patients due to accidental injury. The postoperative mortality rate was 0% despite a morbidity rate of 62%. Patient's intractable abdominal and/or back pain was completely relieved immediately after surgery. Contrary to expectations, postoperative diarrhea was mild. The surgical margins, including the retroperitoneum, were clear histologically (R0 resection) in all patients. The 1- and 2-year survival rates were 51% and 14%, respectively, and median survival was 12.2 months. The site of recurrence was the liver in six patients and retroperitoneum in one.
Conclusions
Distal pancreatectomy with en bloc resection of the celiac artery is feasible and safe, offers a high resectability rate, and has dramatic analgesic effect. Local control of disease is excellent despite frequent hepatic recurrence.
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References
Nordback IH, Hruban RH, Boitnott JK, Pitt HA, Cameron JL (1992) Carcinoma of the body and tail of the pancreas. Am J Surg 164:26–31
Johnson CD, Schwall G, Flechtenmacher J, Trede M (1993) Resection for adenocarcinoma of the body and tail of the pancreas. Br J Surg 80:1177–1179
Fabre JM, Houry S, Manderscheid JC, Huguier M, Baumel H (1996) Surgery for left-sided pancreatic cancer. Br J Surg 83:1065–1970
Ozaki H, Kinoshita T, Kosuge T, Yamamoto J, Shimada K, Inoue K, Koyama Y, Mukai K (1996) An aggressive therapeutic approach to carcinoma of the body and tail of the pancreas. Cancer 77:2240–2245
Brennan MF, Moccia RD, Klimstra D (1996) Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 223:506–511
Sperti C, Pasquali C, Pedrazzoli S (1997) Ductal adenocarcinoma of the body and tail of the pancreas. J Am Coll Surg 185:255–259
Kayahara M, Nagakawa T, Ueno K, Ohta T, Kitagawa H, Arakawa H, Yagi H, Tajima H, Miwa K (1998) Distal pancreatectomy: does it have a role for pancreatic body and tail cancer. Hepatogastroenterology 45:827–832
Andren-Sandberg A, Wagner M, Tihanyi T, Lofgren P, Friess H (1999) Technical aspects of left-sided pancreatic resection for cancer. Dig Surg 16:305–312
Nimura Y, Hattori T, Miura K, Nakajima N, Hibi M (1976) Experience of Appleby's operation for advanced carcinoma of the pancreatic body and tail (in Japanese). Shujutsu 30:885–889
Mayumi T, Nimura Y, Kamiya J, Kondo S, Nagino M, Kanai M, Miyachi M, Hamaguchi K, Hayakawa N (1997) Distal pancreatectomy with en bloc resection of the celiac artery for carcinoma of the body and tail of the pancreas. Int J Pancreatol 22:15–21
Kimura W, Han I, Furukawa Y, Sunami E, Futakawa N, Inoue T, Shinkai H, Zhao B, Muto T, Makuuchi M, Komatsu H (1997) Appleby operation for carcinoma of the body and tail of the pancreas. Hepatogastroenterology 44:387–393
Konishi M, Kinoshita T, Nakagori T, Inoue K, Oda T, Kimata T, Kikuchi H, Ryu M (2000) Distal pancreatectomy with resection of the celiac axis and reconstruction of the hepatic artery for carcinoma of the body and tail of the pancreas. J Hepatobiliary Pancreat Surg 7:183–187
Miyakawa S, Horiguchi A, Hanai T, Mizuno K, Ishihara S, Niwamoto N, Iwase Y, Asano Y, Furusawa K, Miura K, Kainuma M (2002) Monitoring hepatic venous hemoglobin oxygen saturation during Appleby operation for pancreatic cancer. Hepatogastroenterology 49:817–821
Appleby LH (1953) The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer 6:704–707
Kondo S, Katoh H, Shimizu T, Omi M, Hirano S, Ambo Y, Okushiba S, Morikawa T (2000) Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepatogastroenterology 47:1447–1449
Kondo S, Ambo Y, Katoh, H, Hirano S, Tanaka E, Okushiba S, Morikawa T, Igawa H, Yamamoto Y, Sugihara T (2003) Middle colic artery-gastroepiploic artery bypass for compromised collateral flow in distal pancreatectomy with celiac artery resection. Hepatogastroenterology (in press)
International Union Against Cancer (UICC) (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York
Dalton RR, Sarr MG, van Heerden JA, Colby TV (1992) Carcinoma of the body and tail of the pancreas: is curative resection justified? Surgery 111:489–494
Fortner JG, Kim DK, Cubilla A, Turnbull A, Pahnke LD, Shils ME (1977) Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection. Ann Surg 186:42–50
Kondo S, Katoh H, Omi M, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, Kanai M, Yano T (2001) Radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for advanced cancer of the pancreatic body: a preliminary report on perfect pain relief. JOP 2:93–97
Arnoletti JP, Hoffman JP, Ross EA, Kagan SA, Meropol NJ, Freedman G, Eisenberg B (2002) Preoperative chemoradiation in the management of adenocarcinoma of the body of the pancreas. Am Surg 68:330–335
Takahashi T, Ishikura H, Motohara T, Okushiba S, Dohke M, Katoh H (1997) Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol 65:164–170
Nukui Y, Picozzi VJ, Traverso LW (2000) Interferon-based adjuvant chemoradiation therapy improves survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 179:367–371
Rini BI, Zimmerman T, Stadler WM, Gajewski TF, Vogelzang NJ (2002) Allogeneic stem-cell transplantation of renal cell cancer after nonmyeloablative chemotherapy: feasibility, engraftment, and clinical results. J Clin Oncol 20:2017–2024
Pedrazzoli P, Da Prada GA, Giorgiani G, Schiavo R, Zambelli A, Giraldi E, Landonio G, Locatelli F, Siena S, Della Cuna GR (2002) Allogeneic blood stem cell transplantation after a reduced-intensity, preparative regimen: a pilot study in patients with refractory malignancies. Cancer 94:2409–2415
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An erratum to this article can be found at http://dx.doi.org/10.1007/s00423-003-0393-3
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Kondo, S., Katoh, H., Hirano, S. et al. Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body. Langenbecks Arch Surg 388, 101–106 (2003). https://doi.org/10.1007/s00423-003-0375-5
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DOI: https://doi.org/10.1007/s00423-003-0375-5