Is celiac axis resection justified for T4 pancreatic body cancer?

Yamamoto, Yusuke; Sakamoto, Yoshihiro; Ban, Daisuke; Shimada, Kazuaki; Esaki, Minoru; Nara, Satoshi; Kosuge, Tomoo

doi:10.1016/j.surg.2011.06.030

Cited by 77 publications

(101 citation statements)

References 23 publications

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“…Ischemic gastropathy with a considerable incidence [1,3,10] can lead to lethal complications such as stomach necrosis, poor nutritional status, and failure to complete postoperative adjuvant chemotherapy. In a previous study, the majority of patients underwent combined total gastrectomy to prevent gastric ischemic complications during LGA-resecting DP-CAR [5] . Depending on anatomical features or tumor position, the LGA was divided with CA and tumor.…”

Section: Discussionmentioning

confidence: 99%

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Left Gastric Artery Reconstruction after Distal Pancreatectomy with Celiac Axis En-Bloc Resection: How We Do It

Okada¹,

Hirono²,

Kawai³

et al. 2017

Gastrointest Tumors

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Background/Aims: Ischemic gastropathy remains as a persistent problem after left gastric artery (LGA) resection in distal pancreatectomy with celiac axis en-bloc resection (DP-CAR). The middle colic artery (MCA) was found to be a useful vessel for compromised collateral flow. However, intraoperative gross evaluation of gastric ischemia is technically difficult even after artery reconstruction. Methods: We performed LGA reconstruction by MCA-LGA bypass after LGA-resecting DP-CAR assisted by intraoperative indocyanine green fluorescence imaging (ICG) blood flow evaluation in a clinical trial (UMIN000020414). The LGA was reconstructed with the MCA microscopically by plastic surgeons with an everting interrupted suture in end-to-end anastomosis. Results: We could evaluate ICG blood flow not only in the reconstructed artery, but also simultaneously in the gastric wall through a monitor connected to a detector. We could also assess the congestive status of the gastric wall by ICG disappearance from the gastric wall. Conclusion: We present LGA reconstruction by MCA-LGA bypass after LGA-resecting DP-CAR. We conducted a perioperative assessment of ischemic gastropathy to confirm the feasibility and safety of this procedure.

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Section: Discussionmentioning

confidence: 99%

“…Although favorable results of DP-CAR in terms of avoiding ischemic gastropathy have been reported [4] , delayed gastric emptying and ischemic gastropathy after LGA-resecting DP-CAR remain a persistent problem [4,5] . A previous study reported that the middle colic artery (MCA) is a useful vessel for compromised collateral flow [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Left Gastric Artery Reconstruction after Distal Pancreatectomy with Celiac Axis En-Bloc Resection: How We Do It

Okada¹,

Hirono²,

Kawai³

et al. 2017

Gastrointest Tumors

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“…A high rate of complete resection and favorable prognosis (estimated overall 5-year survival rate of 42%) could be observed in selected patients with distal pancreatectomy with en bloc coeliac axis resection for locally advanced pancreatic body cancer (Figure 4) [27,28].…”

Section: Arterial Resectionsmentioning

confidence: 99%

The Role of Vascular Resection in Pancreatic Cancer Treatment

Vladov¹,

Takorov²,

Lukanova³

2017

Challenges in Pancreatic Pathology

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Currently, porto-mesenteric vein resection is a standard procedure at high-volume pancreatic centers. Experience in vascular surgery is indispensable for a modern pancreatic surgeon. Nowadays, only arterial resections still are a controversial issue. Nevertheless, attempts at resection involving reconstruction of the main arteries such as the coeliac axis, hepatic artery, and superior mesenteric artery (SMA) have been reported, although in small case series. An overview of the historical and contemporary methods for surgical management of superior mesenteric/portal vein involvement as well as arterial involvement by pancreatic cancer is presented. We compare the data from the literature with our data based on the examination and long-term follow-up of more than 300 radical pancreatic resections. Seventy-two of the presented patients underwent pancreatic resection with simultaneous vascular resection-SMPV in 65 cases (44 with resection of the portal vein, 15 with resection of the superior mesenteric vein, 6 with resection of the portomesenterial confluence), arterial in 2 and partial resections of IVC in 5 cases. Combined vascular resections were done in three cases. Both groups PVR and PR showed similarly close results in complication rates, mortality, and morbidity. Three and 5 years survival rates were 42 and 38% in PD group and 28 and 19% in the PVR group. The vascular resection must be performed only upon carefully selected patients with data for presence of resectable tumors or tumors with borderline resectability from the preoperative imaging studies. The prompt management of pancreatic cancer with vascular involvement should involve multidisciplinary consultation in high-volume centers.

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“…Current oncological guidelines suggest that pancreatic tumours invading arterial structures render these cancers inoperable [10] . Nevertheless, attempts at resection involving reconstruction of the main arteries such as the coeliac axis, hepatic artery and superior mesenteric artery (SMA) have been reported, albeit in small case series [8,[11][12][13][14][15][16] . The study population for the meta-analysis is the largest in the published literature despite the unsurprising heterogeneity of the 26 studies that met inclusion criteria; a limitation acknowledged by the authors.…”

Section: Commentary On Hot Topicsmentioning

confidence: 99%

Is there a role for arterial reconstruction in surgery for pancreatic cancer?

Ravikumar

Holroyd²,

Fusai³

2013

WJGS

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Surgery remains the only potentially curative treatment for patients with pancreatic cancer. Locally advanced pancreatic cancer with vascular involvement remains a surgical challenge because high perioperative risk and the uncertainty of a survival benefit. Whilst portal vein resection has started to gather momentum because the perioperative morbidity and long term survival is comparable to standard pancreatectomy, there isn't yet a consensus on arterial resections. There have been various reports and case series of arterial resections in pancreatic cancer, with mixed survival results. Mollberg et al have appraised the heterogeneous published literature available on arterial resection in pancreatic cancer in an attempt to compare this to standard pancreatectomy. In this article, we discuss the results of this systematic review and meta-analysis, and the limitations associated with analysing results from heterogenous data. We have outlined the important features in surgery for pancreatic cancer and specifically to arterial resections, and compared arterial resections to the published literature on venous resections.

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Is celiac axis resection justified for T4 pancreatic body cancer?

Cited by 77 publications

References 23 publications

Left Gastric Artery Reconstruction after Distal Pancreatectomy with Celiac Axis En-Bloc Resection: How We Do It

Left Gastric Artery Reconstruction after Distal Pancreatectomy with Celiac Axis En-Bloc Resection: How We Do It

The Role of Vascular Resection in Pancreatic Cancer Treatment

Is there a role for arterial reconstruction in surgery for pancreatic cancer?

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