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Pancreaticoduodenetomy combined with hepatic artery resection following preoperative hepatic arterial embolization
Author(s) -
Yoshidome Hiroyuki,
Shimizu Hiroaki,
Ohtsuka Masayuki,
Yoshitomi Hideyuki,
Kato Atsushi,
Furukawa Katsunori,
Miyazaki Masaru
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.192
Subject(s) - medicine , pancreaticoduodenectomy , arterial embolization , embolization , artery , common hepatic artery , superior mesenteric artery , surgery , hepatic artery embolization , gastroduodenal artery , radiology , gastroenterology , resection
Abstract Background The possibility of resection for locally advanced pancreatic ductal adenocarcinoma ( PDAC ) with involvement of hepatic or superior mesenteric artery is low. The treatment strategy for these locally advanced PDAC needs to be elucidated. Methods We retrospectively reviewed the medical records of 107 patients undergoing pancreaticoduodenectomy for PDAC between 2007 and 2012. Among these patients, seven patients who had unresectable PDAC because of cancer involvement of hepatic artery underwent preoperative hepatic arterial embolization and subsequent pancreaticoduodenectomy combined with resection of hepatic artery without reconstruction ( PDCAR ). We specifically focused on these seven patients to clarify the benefit and drawback of PDCAR . Results Serum alanine aminotransferase ( ALT ) and aspartate aminotransferase ( AST ) levels on 1 day after hepatic arterial embolization increased, but returned to baseline before pancreaticoduodenectomy. There was no arterial embolization‐related complication before surgery. Serum ALT and AST levels increased 1 day after surgery, but thereafter returned to baseline. Although postoperative morbidity such as hepatic infarction was observed in one case, there were no in‐hospital deaths. The median survival time was 12.6 months and 5‐year survival rate was 19%. Conclusion Preoperative hepatic arterial embolization and subsequent PDCAR might be a feasible procedure in selected patients with unresectable locally advanced PDAC with hepatic artery involvement.