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Distal pancreatectomy with en bloc celiac axis resection (DP‐CAR) and arterial reconstruction: Techniques and outcomes
Author(s) -
Addeo Pietro,
Guerra Martina,
Bachellier Philippe
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26424
Subject(s) - medicine , surgery , pancreatectomy , arterial embolization , artery , resection , embolization
Background Ischemic complications are still prevalent after distal pancreatectomy with en bloc celiac axis resection (DP‐CAR) despite the use of preoperative arterial embolization. We described our institutional experience with arterial reconstruction during DP‐CAR. Methods We retrospectively reviewed short‐ and long‐term outcomes of all DP‐CAR performed for pancreatic adenocarcinoma between January 1, 1995 and March 30, 2020. Outcomes were compared according to the presence of arterial reconstruction. Results Sixty consecutive DP‐CARs were reviewed. Most patients underwent induction chemotherapy (85%) based on FOLFIRINOX protocol (80.3%). The hepatic artery was reconstructed in 50 patients (83.3%). The left gastric artery was reconstructed in 4 and preserved in 14 patients. A venous resection was associated during 44 DP‐CARs (36 segmental venous resections/8 lateral venous resections). Ninety days mortality was 5.0% with 48.3% ( n = 29) overall rate of morbidity. Postoperative outcomes in term of mortality, morbidity, and ischemic events between patients with and without arterial reconstruction were similar despite a higher rate of venous resection (81% vs. 40%; p = 0.005) and more complex cases (Mayo clinic DP‐CARs class 1B, 2A, and 3A) in the reconstructed group. Conclusion Arterial reconstruction represents a safe surgical option during DP‐CAR to lessen postoperative ischemic events. This technique, reserved to high volume centers expert in vascular resection during pancreatectomy, deserves further comparison with standard technique in a larger setting.