Clinical significance of liver ischaemia after pancreatic resection

Hackert, Thilo; Stampfl, Ulrike; Schulz, H.; Strobel, Oliver; Büchler, Markus W.; Werner, Jens

doi:10.1002/bjs.7675

Cited by 44 publications

(20 citation statements)

References 25 publications

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“…The ischemic complication in the liver rarely occurs after pancreatic resection, but it can cause a fatality when it happens. Hackert et al reported the influence of liver ischemia on clinical outcome after pancreatic resection [18]. Postoperative blood flow insufficiency in the liver caused sepsis and multiple organ failure in 5 of 17 patients (29.4%) who had ischemic complications.…”

Section: Discussionmentioning

confidence: 99%

Is hepatic artery coil embolization useful in distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer?

et al. 2019

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Background The exact contribution of preoperative coil embolization in distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for the prevention of ischemic liver complication is not fully elucidated. Methods From January 2004 to July 2015, 31 patients underwent DP-CAR for the pancreatic body–tail cancer. Twenty-three patients received preoperative coil embolization. The characteristics and operative outcomes were analyzed retrospectively. Results The median survival time and 1- and 3-year overall survival rates were 23.7 months and 74.2% and 34.4%, respectively. No 30-day mortality occurred in any of the patients. Postoperative liver infarction developed only in 8 patients (25.8%) even though 7 of 8 patients had undergone preoperative coil embolization. Tumor contact with the gastroduodenal artery (GDA)/proper hepatic artery (PHA) on preoperative multi-detector computed tomography (MDCT), tumor size, operative time, portal vein resection, and stenosis of the GDA/PHA after DP-CAR are related to liver infarction. Among them, postoperative stenosis of the GDA/PHA on MDCT, which was observed in all 8 patients with liver infarction, was the most closely related factor to postoperative liver infarction. Tumor contact with the GDA/PHA did not worsen the R0 resection rate or overall survival rate. Conclusion Our data indicate that preoperative coil embolization of the common hepatic artery is not useful in DP-CAR as long as GDA is completely preserved during surgery.

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Section: Discussionmentioning

confidence: 99%

Is hepatic artery coil embolization useful in distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer?

et al. 2019

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“…Patients undergoing pancreatic resection without additional risk factors have a risk of liver ischemia of 2.2% [5]. Simultaneous involvement of the portal vein and hepatic artery was always fatal.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Artery Embolization prior to En Bloc Resection of an Encased Common Hepatic Artery in Adenocarcinoma of the Head of the Pancreas

Sergeant

Schadde

Maleux

et al. 2013

Case Reports in Medicine

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A 64-year-old female patient with adenocarcinoma of the head of the pancreas with encasement of the common hepatic artery and portal vein stenosis was reexplored after six cycles of gemcitabine (1000 mg/m2). Prior to surgery, the patient underwent balloon dilation and stenting of the portal vein in addition to successful coil embolisation of the common hepatic artery, proper hepatic artery, and proximal gastroduodenal artery. After embolisation, a pylorus-preserving pancreaticoduodenectomy was performed with resection of the common hepatic artery and portal vein confluens. Pathological examination showed a moderately differentiated pT3N0 (Stage IIa, TNM 7th edition) tumor with negative section margins. We show with this case that in selected cases of periampullary cancer with encasement of the common hepatic artery, it is technically feasible to perform pancreaticoduodenectomy with hepatic artery resection and negative surgical margins. Nevertheless, the oncological benefit of extended arterial resections remains controversial.

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“…Liver ischemia can occur in case of thrombotic occlusion of a reconstructed hepatic artery or celiac axis, respectively, and is characterized postoperatively by strongly increasing liver enzymes as well as a vascular flow decrease in ultrasound or CT examination. Especially when a synchronous venous resection and reconstruction has been performed, this complication may be aggravated by venous thrombosis leading to fatal liver ischemia and requiring an immediate surgical or interventional management to restore adequate arterial (and portovenous) inflow (17).…”

Section: Surgical Considerations Of Arterial Resection and Replacementmentioning

confidence: 99%

Radical pancreatic cancer surgery—with arterial resection

Klaiber

Mihaljevic

Hackert

2019

Transl. Gastroenterol. Hepatol

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Extended surgery with arterial resection in pancreatic cancer remains a controversial topic. Although not recommended as a standard procedure, arterial resection may be feasible in selected patients and with the availability of new multimodal treatment approaches it may gain increasing impact in pancreatic cancer therapy as a complete tumor removal is still the only opportunity to achieve long-term survival for this disease. With regard to the surgical approach, one must differentiate between resection and reconstruction of the celiac axis and the hepatic artery as its most important branch, and resection/reconstruction of the superior mesenteric artery. Both procedures are technically possible and require a distinct level of surgical experience as well as interdisciplinary management for preoperative diagnosis and treatment of postoperative complications to achieve good outcomes. Besides arterial resection followed by reconstruction, there are specific situations when arteries may be resected without reconstruction, e.g., during distal pancreatectomy with celiac axis resection. In addition, in some cases arterial resections can be avoided despite a suspected tumor attachment by sharp dissection on the adventitial layer of the respective artery, especially after neoadjuvant therapy which is increasingly performed for borderline resectable and locally advanced tumor findings. This review summarizes definitions, diagnostics, technical aspects and outcomes of arterial resection in pancreatic cancer surgery in the context of the current literature and evidence.

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Clinical significance of liver ischaemia after pancreatic resection

Abstract: Postoperative liver perfusion failure is a rare but potentially severe complication following pancreatic surgery requiring immediate recognition and, if necessary, radiological or surgical intervention.

Cited by 44 publications

References 25 publications

Is hepatic artery coil embolization useful in distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer?

Is hepatic artery coil embolization useful in distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer?

Hepatic Artery Embolization prior to En Bloc Resection of an Encased Common Hepatic Artery in Adenocarcinoma of the Head of the Pancreas

Radical pancreatic cancer surgery—with arterial resection

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