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Details and Outcomes of Distal Pancreatectomy with Celiac Axis Resection Preserving the Left Gastric Arterial Flow

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To describe the technical details and efficacy of distal pancreatectomy with celiac axis resection (DP-CAR) and left gastric artery (LGA) flow preservation for pancreatic ductal adenocarcinoma (PDAC).

Method

This single-center, retrospective analysis investigated short- and long-term outcomes of DP-CAR performed on 55 patients with PDAC from 2011 to 2019. Our method included LGA reconstruction after total resection of the CA (rDP-CAR group; 24 patients) or LGA preservation if the tumor invasion was away from its root (pDP-CAR group; 31 patients), a CA-first approach to reduce blood loss during dissection, and conservative drain management with or without jejunal serosal patching at the pancreatic stump.

Results

Among the study patients, 23 had locally advanced PDAC and 22 had borderline resectable PDAC. Median operation duration was 443 min (248–810), estimated blood loss was 600 mL (150–2280), and incidence of transfusion was 2%. Ischemic complications occurred exclusively in the rDP-CAR group, including two patients with ischemic gastropathy (8%) and three patients with findings of liver ischemia on computed tomography (13%). One patient underwent relaparotomy for stomach perforations, and 19 patients (35%) had pancreatic fistula, including 8 patients who underwent conservative drain placement for more than 3 weeks without specific symptoms. There were no Clavien–Dindo grade 4 or higher postoperative complications. Preoperative therapy showed improved 3-year overall survival rates than without (54% vs. 37%, p = 0.027).

Conclusions

Using the standardized technique, DP-CAR was safely performed with no mortality and acceptable long-term survival.

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Disclosures

Yosuke Inoue, Akio Saiura, Takafumi Sato, Atsushi Oba, Yoshihiro Ono, Yoshihiro Mise, Hiromichi Ito, and Yu Takahashi have no disclosures to declare.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Yosuke Inoue MD, PhD, Akio Saiura MD, PhD, Takafumi Sato MD, PhD, Atsushi Oba MD, PhD, Yoshihiro Ono MD, PhD, Yoshihiro Mise MD, PhD, Hiromichi Ito MD & Yu Takahashi MD, PhD

  2. Department of Hepatobiliary Pancreatic Surgery, Juntendo University Hospital, Tokyo, Japan

    Akio Saiura MD, PhD & Yoshihiro Mise MD, PhD

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  1. Yosuke Inoue MD, PhD
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Correspondence to Yosuke Inoue MD, PhD.

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Inoue, Y., Saiura, A., Sato, T. et al. Details and Outcomes of Distal Pancreatectomy with Celiac Axis Resection Preserving the Left Gastric Arterial Flow. Ann Surg Oncol 28, 8283–8294 (2021). https://doi.org/10.1245/s10434-021-10243-3

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