A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy

Abstract

For pancreatic ductal adenocarcinoma (PDAC) of the head and/or body invading the splenic artery (SA), we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR). We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD) for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n = 66) and PD-SAR (n = 18). Most patients were treated by preoperative chemoradiotherapy (CRT). Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, P = 0.538), despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.

Significance of Simultaneous Splenic Artery Resection in Left‐Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection

“…PD-SAR is a simple procedure comparing to the techniques such as SV–IMV anastomosis and SV-PV/SMV anastomosis, and we had already proven that PD-SAR can maintain blood supply of the remnant pancreatic tail and spleen as well as postoperative pancreatic functions [11]. In fact, there were no surgical complications related to SA resection in the present study, revealing that PD-SAR prevented splenomegaly and maintained platelet counts.…”

Partial pancreatic tail preserving subtotal pancreatectomy for pancreatic cancer: Improving glycemic control and quality of life without compromising oncological outcomes

“…Therefore, the outcomes of our study were not surprising. However, if the texture of the pancreatic remnant is normal (nonfibrotic), it is unknown whether PPTP-SP is feasible[ 48 ], and pancreaticoduodenectomy with SA resection (PD-SAR) can be considered as a therapeutic option[ 50 ]. Meanwhile, the relationship between the pancreatic stump volume and its endocrine function needs to be further evaluated.…”

Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

“…Studies in English assessing resection of pancreatic cancer in curative intent including resection of major visceral arteries (celiac trunk and/or SMA and/or common hepatic artery), with or without a control group of patients undergoing pancreatic resection without arterial resection, were included. Studies reporting on splenic artery resection were excluded [10]. Studies published before 2011 were also not included, as for example the study by Bockhorn et al [11].…”