Pancreatectomy with Celiac Axis Resection and Reconstruction for Locally Advanced Pancreatic Cancer.

Autor: Mizutani, Satoshi, Taniai, Nobuhiko, Sukegawa, Makoto, Haruna, Takahiro, Furuki, Hiroyasu, Takata, Hideyuki, Ueda, Junji, Yoshioka, Masato, Aimoto, Takayuki, Sakamoto, Shunichiro, Suzuki, Kenji, Nakamura, Yoshiharu, Yoshida, Hiroshi
Zdroj: Cancers; Dec2024, Vol. 16 Issue 23, p4115, 18p
Abstrakt: Simple Summary: With the advent of effective chemotherapy, conversion surgery (CS) has been performed in patients who have responded to pretreatment, even for pancreatic cancer diagnosed as unresectable (UR) at the time of initial diagnosis. In CS, major arterial resection and reconstruction are necessary for complete radical resection. Many patients who require celiac axis (CA) resection combined with reconstruction have large tumors, poor findings of spread to surrounding tissues, and tumor invasion near the Abdominal Aorta; therefore, ingenuity is required for a safe resection. Furthermore, CA resection combined with reconstruction after specimen removal requires skills and experience in vascular surgery, such as selecting the arterial anastomosis site and the vessels to be used for bypass. We discuss the key points for safely performing pancreatectomy with CA resection combined with reconstruction, divided into resection (how to create "golden view") and arterial reconstruction. Background: With the advent of effective chemotherapy, conversion surgery (CS) has been performed in patients who have responded to pretreatment, even for pancreatic cancer diagnosed as unresectable (UR) at the time of initial diagnosis. In CS, major arterial resection and reconstruction are necessary for complete radical resection. Methods: We discuss the key points for safely performing pancreatectomy with celiac axis (CA) resection combined with reconstruction, divided into resection and arterial reconstruction. The possibility of safe pancreatectomy concurrent with CA resection and reconstruction depends on the ability to create a "golden view" that provides an unimpaired view of the Abdominal Aorta, CA, Superior Mesenteric Artery, Inferior Vena Cava, and left renal vein from the ventral side. Pancreatectomy concurrent with CA resection requires arterial reconstruction. Postoperatively, arterial blood flow must be maintained. To achieve this, tension-free and short bypass should be observed. Results: From 2014 to 2024, sixteen URLA patients underwent CS, requiring major artery en bloc resection after pretreatment. We performed DP-CAR in eight patients, gastrectomy-distal pancreatectomy-splenectomy (Appleby procedure) procedure in one patient, PD-CHAR in two patients, PD-CAR in two patients, TP-CAR(spleen preserving) in one patient, and TP-CAR+TG in two patients. In total, five patients required surgery with CA reconstruction. Histopathologically, four of the five patients had T4 pancreatic cancer. The R0 surgical rate was 80%. Complication of Clavien–Dindo IIIa or higher was observed in one patient. There were no deaths. Conclusions: Parallel to the determination of pretreatment, surgeons must be prepared to safely and reliably perform pancreatectomies that require concurrent major arterial resection and reconstruction. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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