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Long-term survival after distal pancreatectomy with celiac axis resection and hepatic artery reconstruction in the setting of locally advanced unresectable pancreatic cancer

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Abstract

The long-term survival of patients with locally advanced, unresectable pancreatic cancer is extremely poor. We present our experience with a 67-year-old woman who had a 40-mm mass in the body of the pancreas. Tumor infiltration reached the gastroduodenal artery, celiac artery, common hepatic artery, and splenic artery. After 10 courses of FOLFIRINOX, 2 courses of gemcitabine plus nab-paclitaxel, and 6 courses of gemcitabine alone, we performed distal pancreatectomy with celiac axis resection and hepatic artery reconstruction. The bifurcation of the gastroduodenal artery and the proper hepatic artery had to be resected, after which we created 2 anastomoses: proper hepatic-to-middle colic artery, and second jejunal-to-right gastroepiploic artery. Histopathologic examination revealed an Evans grade IIb histologic response to prior treatment and verified the R0 resection status. The patient was discharged on postoperative day 30 after treatment of a grade B pancreatic fistula and is still alive, without recurrence, more than 5 years after initiation of treatment. This patient with locally advanced, unresectable pancreatic cancer achieved long-term survival through perioperative multidisciplinary treatment, including distal pancreatectomy with celiac axis resection and hepatic artery reconstruction. This aggressive procedure could be a treatment option for patients with locally advanced, unresectable pancreatic cancer.

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Abbreviations

URLA:

Unresectable, locally advanced

PC:

Pancreatic cancer

DP-CAR:

Distal pancreatectomy with celiac axis resection

DUPAN-2:

Duke pancreatic monoclonal antigen type 2

SPAN-1:

S-pancreas antigen-1

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19-9

CT:

Computed tomography

CTCAE:

Common Terminology Criteria for Adverse Events

RECIST:

Response Evaluation Criteria in Solid Tumors

FFX:

FOLFIRINOX

GnP:

Gemcitabine plus nab-paclitaxel

Gem:

Gemcitabine

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Biochemical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yoshiyuki Shibata, Kenichiro Uemura, Naru Kondo, Tatsuaki Sumiyoshi, Kenjiro Okada, Shingo Seo, Hiroyuki Otsuka & Shinya Takahashi

  2. Department of Gastroenterology Center, Hiroshima Memorial Hospital, 1-4-3 Honkawa-cho, Naka-ku, Hiroshima, 730-0802, Japan

    Yoshiaki Murakami

  3. Department of Advanced Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yoshiaki Murakami

  4. Department of Anatomical Pathology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Kouji Arihiro

Authors
  1. Yoshiyuki Shibata
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  2. Kenichiro Uemura
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  3. Naru Kondo
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  4. Tatsuaki Sumiyoshi
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  5. Kenjiro Okada
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  6. Shingo Seo
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  7. Hiroyuki Otsuka
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  8. Yoshiaki Murakami
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  9. Kouji Arihiro
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  10. Shinya Takahashi
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Correspondence to Kenichiro Uemura.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Shibata, Y., Uemura, K., Kondo, N. et al. Long-term survival after distal pancreatectomy with celiac axis resection and hepatic artery reconstruction in the setting of locally advanced unresectable pancreatic cancer. Clin J Gastroenterol 15, 635–641 (2022). https://doi.org/10.1007/s12328-022-01621-9

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  • DOI: https://doi.org/10.1007/s12328-022-01621-9

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