Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
Department of Diagnostic and Interventional Radiology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
Langenbecks Arch Surg. 2023 May 4;408(1):174. doi: 10.1007/s00423-023-02860-1.
Locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) involving the celiac artery (CeA), the common hepatic artery and the gastroduodenal artery (GDA) is considered unresectable. We developed the novel procedure of pancreaticoduodenectomy with celiac artery resection (PD-CAR) for such LA-PDACs.
From 2015 to 2018, we performed curative pancreatectomy with major arterial resection for 13 LA-PDACs as a clinical study (UMIN000029501). Of those, four patients with pancreatic neck cancer involving the CeA and GDA were candidates for PD-CAR. Prior to surgery, blood flow alterations were performed to unify the blood flow to the liver, stomach, and pancreas, resulting in feeding from the cancer-free artery. During PD-CAR, arterial reconstruction of the unified artery was performed as needed. Based on the records of PD-CAR cases, we retrospectively analyzed the validity of the operation.
R0 resection was achieved in all patients. Arterial reconstruction was performed in three patients. In another patient, the hepatic arterial flow was maintained by preserving of the left gastric artery. The mean operative time was 669 min, and the mean blood loss was 1003 ml. Although Clavien-Dindo classification III-IV postoperative morbidities occurred in three patients, no reoperations nor mortalities occurred. Although two patients died of cancer recurrence, one patient survived for 26 months without recurrence (died of cerebral infarction), and another is alive at 76 months without recurrence.
PD-CAR, which enabled R0 resection and preservation of the residual stomach, pancreas, and spleen, provided acceptable postoperative outcomes.
累及腹腔动脉（CeA）、肝总动脉和胃十二指肠动脉（GDA）的局部进展期胰腺导管腺癌（LA-PDAC）被认为无法切除。我们为这些 LA-PDAC 开发了新的胰十二指肠切除术联合腹腔动脉切除术（PD-CAR）。
2015 年至 2018 年，我们进行了 13 例 LA-PDAC 的根治性胰切除术和主要动脉切除术的临床研究（UMIN000029501）。其中，4 例胰头颈部癌累及 CeA 和 GDA 的患者为 PD-CAR 的候选者。在手术前，进行血流改变以统一肝脏、胃和胰腺的血流，使癌症无血管区域供血。在 PD-CAR 过程中，根据需要进行统一动脉的动脉重建。根据 PD-CAR 病例的记录，我们回顾性分析了该手术的有效性。
所有患者均实现了 R0 切除。3 例患者进行了动脉重建。在另一名患者中，通过保留胃左动脉维持肝动脉血流。手术时间平均为 669 分钟，出血量平均为 1003 毫升。尽管 3 例患者发生了 Clavien-Dindo 分类 III-IV 级术后并发症，但无再次手术或死亡。尽管 2 例患者死于癌症复发，但 1 例患者无复发生存 26 个月（死于脑梗死），另 1 例患者无复发生存 76 个月。
PD-CAR 能够实现 R0 切除，并保留残胃、胰腺和脾脏，提供了可接受的术后结果。
