Skip to main content

Advertisement

SpringerLink
Log in

Pancreatectomy with Hepatic Artery Resection for Pancreatic Head Cancer

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

To report our experiences and outcome of pancreatectomy with hepatic artery resection (PT-HAR) for advanced pancreatic head cancer.

Methods

A retrospective study of clinical data from 14 patients with advanced pancreatic ductal adenocarcinoma undergoing PT-HAR in a tertiary academic center between March 2010 and June 2017 was performed. Furthermore, a comparison in a match-pair analysis (1:3) with patients received standard pancreatectomy during the same period was conducted to evaluate the clinical outcome.

Results

The PT-HAR cohort included pancreaticoduodenectomy (n = 11) and total pancreatectomy (n = 3). Of them, six underwent portal/superior mesenteric vein resection and reconstruction and three underwent hepatic artery reconstruction. Four patients without arterial reconstruction developed liver perfusion failure. No perioperative mortality occurred, with a median postoperative hospital stay of 10.5 days (range 6–39). The median overall survival was 30 months (95% confidence interval 9.8–50.2 months), with the 1-, 2-, and 3-year survival rates of 81.8%, 63.6%, and 42.4%, respectively. The matched-pair data analysis showed no significant differences between PT-HAR and standard pancreatectomy, except that liver perfusion failure occurred more frequently after PT-HAR.

Conclusions

PT-HAR can be performed with acceptable morbidity, mortality, and survival for advanced pancreatic head cancer. Considering the potential risk of liver perfusion failure, only highly selected patients are eligible for PT-HAR without reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Lin QJ, Yang F, Jin C et al (2015) Current status and progress of pancreatic cancer in China. World J Gastroenterol 21(26):7988–8003

    Article  Google Scholar 

  2. Barreto SG, Windsor JA (2016) Justifying vein resection with pancreatoduodenectomy. Lancet Oncol 17(3):e118–e124

    Article  Google Scholar 

  3. Gaujoux S, Sauvanet A, Vullierme MP et al (2009) Ischemic complications after pancreaticoduodenectomy: incidence, prevention, and management. Ann Surg 249(1):111–117

    Article  Google Scholar 

  4. Hackert T, Stampfl U, Schulz H et al (2011) Clinical significance of liver ischaemia after pancreatic resection. Br J Surg 98(12):1760–1765

    Article  CAS  Google Scholar 

  5. Bachellier P, Rosso E, Fuchshuber P et al (2014) Use of a temporary intraoperative mesentericoportal shunt for pancreatic resection for locally advanced pancreatic cancer with portal vein occlusion and portal hypertension. Surgery 155(3):449–456

    Article  Google Scholar 

  6. Amano H, Miura F, Toyota N et al (2009) Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepatobiliary Pancreat Surg 16(6):850–857

    Article  Google Scholar 

  7. Sarmiento JM, Panneton JM, Nagorney DM (2003) Reconstruction of the hepatic artery using the gastroduodenal artery. Am J Surg 185(4):386–387

    Article  Google Scholar 

  8. Allendorf JD, Bellemare S (2009) Reconstruction of the replaced right hepatic artery at the time of pancreaticoduodenectomy. J Gastrointest Surg 13(3):555–557

    Article  Google Scholar 

  9. Hackert T, Weitz J, Büchler MW (2014) Splenic artery use for arterial reconstruction in pancreatic surgery. Langenbecks Arch Surg 399(5):667–671

    Article  Google Scholar 

  10. Miyazaki M, Yoshitomi H, Takano S et al (2017) Combined hepatic arterial resection in pancreatic resections for locally advanced pancreatic cancer. Langenbecks Arch Surg 402(3):447–456

    Article  Google Scholar 

  11. Yoshidome H, Shimizu H, Ohtsuka M et al (2014) Pancreaticoduodenetomy combined with hepatic artery resection following preoperative hepatic arterial embolization. J Hepatobiliary Pancreat Sci 21(12):850–855

    Article  Google Scholar 

  12. Ichida A, Sakamoto Y, Akahane M et al (2015) Successful case of pancreaticoduodenectomy with resection of the hepatic arteries preserving a single aberrant hepatic artery for a pancreatic neuroendocrine tumor: report of a case. Surg Today 45(3):363–368

    Article  Google Scholar 

  13. Yang F, Long J, Fu DL et al (2008) Aberrant hepatic artery in patients undergoing pancreaticoduodenectomy. Pancreatology 8(1):50–54

    Article  CAS  Google Scholar 

  14. Yang F, Di Y, Li J et al (2015) Accuracy of routine multidetector computed tomography to identify arterial variants in patients scheduled for pancreaticoduodenectomy. World J Gastroenterol 21(3):969–976

    Article  Google Scholar 

  15. Miyazaki M, Ito H, Nakagawa K et al (2000) Unilateral hepatic artery reconstruction is unnecessary in biliary tract carcinomas involving lobar hepatic artery: implications of interlobar hepatic artery and its preservation. Hepatogastroenterology 47(36):1526–1530

    CAS  PubMed  Google Scholar 

  16. Tempero MA, Malafa MP, Al-Hawary M et al (2017) Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 15(8):1028–1061

    Article  Google Scholar 

  17. Yang F, Jin C, Di Y et al (2018) Central pancreatectomy with external drainage of monolayer pancreaticojejunostomy for prevention of postoperative pancreatic fistula: a retrospective cohort study. Int J Surg 51:104–108

    Article  Google Scholar 

  18. Yang F, Jin C, Li J et al (2018) Clinical significance of drain fluid culture after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 25(11):508–517

    Article  Google Scholar 

  19. Yang F, Jin C, Warshaw AL et al (2019) Total pancreatectomy for pancreatic malignancy with preservation of the spleen. J Surg Oncol 119(6):784–793

    Article  Google Scholar 

  20. Yang F, Jin C, Hao S et al (2019) Drain contamination after distal pancreatectomy: incidence, risk factors, and association with postoperative pancreatic fistula. J Gastrointest Surg. https://doi.org/10.1007/s11605-019-04155-7

    Article  PubMed  Google Scholar 

  21. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591

    Article  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  23. DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–937 (discussion 937–939)

    Article  Google Scholar 

  24. Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112(3):337–347

    Article  CAS  Google Scholar 

  25. Kozak GM, Epstein JD, Deshmukh SP et al (2018) Common hepatic artery abutment or encasement is an adverse prognostic factor in patients with borderline and unresectable pancreatic cancer. J Gastrointest Surg 22(2):288–294

    Article  Google Scholar 

  26. Okada K, Kawai M, Hirono S et al (2015) A replaced right hepatic artery adjacent to pancreatic carcinoma should be divided to obtain R0 resection in pancreaticoduodenectomy. Langenbecks Arch Surg 400(1):57–65

    Article  Google Scholar 

  27. Nanashima A, Imamura N, Tsuchimochi Y et al (2016) Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: a case report. Int J Surg Case Rep 25:66–70

    Article  Google Scholar 

  28. Nakamura T, Hirano S, Noji T et al (2016) Distal pancreatectomy with en bloc celiac axis resection (modified appleby procedure) for locally advanced pancreatic body cancer: a single-center review of 80 consecutive patients. Ann Surg Oncol 23(Suppl 5):969–975

    Article  Google Scholar 

  29. Christians KK, Pilgrim CH, Tsai S et al (2014) Arterial resection at the time of pancreatectomy for cancer. Surgery 155(5):919–926

    Article  Google Scholar 

  30. Perinel J, Nappo G, El Bechwaty M et al (2016) Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement. Langenbecks Arch Surg 401(8):1131–1142

    Article  CAS  Google Scholar 

  31. Yang F, Jin C, Fu D (2014) Celiac axis compression syndrome and pancreatic head cancer. Pancreatology 14(4):310–311

    Article  Google Scholar 

  32. van Manen L, Handgraaf HJM, Diana M et al (2018) A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery. J Surg Oncol 118(2):283–300

    Article  Google Scholar 

  33. Bengmark S, Rosengren K (1970) Angiographic study of the collateral circulation to the liver after ligation of the hepatic artery in man. Am J Surg 119(6):620–624

    Article  CAS  Google Scholar 

  34. Kitajima K, Maeda T, Ohno Y et al (2011) Capability of abdominal 320-detector row CT for small vasculature assessment compared with that of 64-detector row CT. Eur J Radiol 80(2):219–223.

    Article  Google Scholar 

  35. Bachellier P, Addeo P, Faitot F et al (2018) Pancreatectomy with arterial resection for pancreatic adenocarcinoma: how can it be done safely and with which outcomes? A single institution's experience with 118 patients. Ann Surg. https://doi.org/10.1097/SLA.0000000000003010

    Article  PubMed  Google Scholar 

  36. Asano T, Nakamura T, Noji T et al (2018) Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction. Langenbecks Arch Surg 403(2):195–202

    PubMed  Google Scholar 

  37. Miura F, Asano T, Amano H et al (2010) Eleven cases of postoperative hepatic infarction following pancreato-biliary surgery. J Gastrointest Surg 14(2):352–358

    Article  Google Scholar 

  38. Landen S, Ursaru D, Delugeau V et al (2017) How to deal with hepatic artery injury during pancreaticoduodenectomy. A systematic review. J Visc Surg 154(4):261–268

    Article  CAS  Google Scholar 

  39. Fukami Y, Kaneoka Y, Maeda A et al (2016) Major hepatopancreatoduodenectomy with simultaneous resection of the hepatic artery for advanced biliary cancer. Langenbecks Arch Surg 401(4):471–478

    Article  Google Scholar 

  40. Stitzenberg KB, Watson JC, Roberts A et al (2008) Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol 15(5):1399–1406

    Article  Google Scholar 

  41. Delpero JR, Boher JM, Sauvanet A et al (2015) Pancreatic adenocarcinoma with venous involvement: is up-front synchronous portal-superior mesenteric vein resection still justified? A survey of the Association Française de Chirurgie. Ann Surg Oncol 22(6):1874–1883

    Article  Google Scholar 

Download references

Acknowledgements

Feng Yang: Supported by the National Key R&D Program of China No. 2017YFC1308604.

Author information

Authors and Affiliations

  1. Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai, 200040, China

    Feng Yang, Xiaoyi Wang, Chen Jin, Hang He & Deliang Fu

Authors
  1. Feng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaoyi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chen Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hang He
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deliang Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FY contributed to the conception and design of this paper, data acquisition, drafting and revising the article, and final approval of the version to be published; XW, CJ, and HH contributed to the conception and design of this paper, data analysis, and final approval of it; DF contributed to the conception and design of this paper, data analysis, and final approval of it.

Corresponding authors

Correspondence to Feng Yang or Deliang Fu.

Ethics declarations

Conflict of interest

We declared no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, F., Wang, X., Jin, C. et al. Pancreatectomy with Hepatic Artery Resection for Pancreatic Head Cancer. World J Surg 43, 2909–2919 (2019). https://doi.org/10.1007/s00268-019-05106-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05106-8

Search

Navigation