Extended Distal Pancreatectomy with En Bloc Resection of the Celiac Axis for Locally Advanced Pancreatic Cancer: A Case Report and Review of the Literature

Abstract

Due to a lack of early symptoms, pancreatic cancers of the body and tail are discovered mostly at advanced stages. These locally advanced cancers often involve the celiac axis or the common hepatic artery and are therefore declared unresectable. The extended distal pancreatectomy with en bloc resection of the celiac artery may offer a chance of complete resection. We present the case of a 48-year-old female with pancreatic body cancer invading the celiac axis. The patient underwent laparoscopy to exclude hepatic and peritoneal metastasis. Subsequently, a selective embolization of the common hepatic artery was performed to enlarge arterial flow to the hepatobiliary system and the stomach via the pancreatoduodenal arcades from the superior mesenteric artery. Fifteen days after embolization, the extended distal pancreatectomy with splenectomy and en bloc resection of the celiac axis was carried out. The postoperative course was uneventful, and complete tumor resection was achieved. This case report and a review of the literature show the feasibility and safety of the extended distal pancreatectomy with en bloc resection of the celiac axis. A preoperative embolization of the celiac axis may avoid ischemia-related complications of the stomach or the liver.

Distal Pancreatectomy With En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Cancer

“…Prophylactic cholecystectomy might be unnecessary unless the arterial blood supply is compromised. Preoperative coil embolization was reported to be an effective method of avoiding postoperative ischemic complications 6 because of enhanced collateral arterial flow. However, whether preoperative embolization decreases the incidence of postoperative ischemic events is unclear.…”

“…Extended distal pancreatectomy with en bloc resection of the celiac artery (DP-CAR) may provide a chance for complete resection of locally advanced pancreatic cancer. 6 However, data regarding DP-CAR are limited. It is unclear whether it is safe and effective, can provide survival benefits similar to DP, or can result in prolonged survival and better quality of life compared to supportive treatments.…”

Should We Perform Arterial Embolization Before Distal Pancreatectomy Combined with En Bloc Resection of the Celiac Axis for Locally Advanced Pancreatic Cancer?

“…In the past, the left gastric artery and/or common hepatic artery was subjected to preoperative embolization (to prevent ischemic complications, such as ischemic gastritis or ischemic hepatopathy) in most patients who underwent DP-CAR, whereas recent studies have suggested that the benefits of preoperative embolization are unclear [4,9]. This study suggested that the absence of preoperative arterial embolization before DP-CAR does not increase the risk of postoperative complications.…”

Distal Pancreatectomy with En Bloc Resection of the Celiac Axis with Preservation or Reconstruction of the Left Gastric Artery in Patients with Pancreatic Body Cancer

“…While our results were slightly higher, they were not clinically problematic. Kondo et al [28] reported the use of preoperative CHA embolization in all their cases to prevent postoperative liver ischemia, and this method has been adopted by some authors [12, 32]. Although we did not introduce this procedure, the postoperative aminotransferase level was tolerable, and no cases of liver necrosis or liver failure occurred.…”