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

Abstract

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.

Pancreaticoduodenetomy combined with hepatic artery resection following preoperative hepatic arterial embolization

“…In addition, there was no inhospital mortality case after PDCAR. This treatment strategy is useful because PDCAR is technically easy to be performed for R0 resection without the necessity of reconstruction of common and proper hepatic artery in conjunction with a previous case report [21,22]. A preservation of arterial flow to the liver is necessary because biliary blood flow is maintained only by hepatic artery.…”

Preoperative segmental embolization of the proper hepatic artery prior to pylorus-preserving pancreaticoduodenectomy: A case report

“…There are previous reports of fifteen patients, reporting the usefulness of preoperative embolization of the hepatic arteries before PD/PPPD ( Table 1 ) [ 8,11–17 ]. The embolized artery and collateral pathways varied in each of these patients.…”