Distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR): Common hepatic arterial stump pressure should determine the need for arterial reconstruction

Systematic review of outcomes after distal pancreatectomy with coeliac axis resection for locally advanced pancreatic cancer

“…A systematic search yielded 19 retrospective studies fulfilling the eligibility criteria ( Fig. ), comprising 240 patients included between 1975 and 2015, with a case‐weighted median age of 63 years ( Table ). The majority of patients for whom pathology was reported had pancreatic ductal adenocarcinoma (188 of 194, 96·9 per cent).…”

“…In group A (40 patients), comprising three studies, less than 50 per cent of patients received (neo)adjuvant therapy. In group B (133 patients), comprising ten studies, more than 50 per cent of patients received (neo)adjuvant therapy. In group C (67 patients), comprising six studies, the (neo)adjuvant regimen was unknown.…”

“…Predefined data extraction forms were used to collect data on variables comprising demographics (sex, age), 23 Japan 1997-2003 7 4 : 3 62 Jing et al 24 China 2005-2010 24 18 : 6 55* Kimura et al 25 Japan 2010-2011 3 1 : 2 66 Konishi et al 26 Japan 1992-1998 4 0 : 4 57 Mayumi et al 27 Japan 1975-1994 6 4 : 2 62 Mittal et al 28 Australia 2007-2014 7 4 : 3 64 Miura et al 29 Japan 1998-2008 50 26 : 24 64 Okada et al 30 Japan 2004-2012 37 22 : 15 66* Shimura et al 31 Japan 1992-2011 14 10 : 4 69 Sperti et al 32 Italy 1989-2007 5 3 : 2 70 Takahashi et al 33 Japan 1993-2010 16 8 : 8 65* Wang et al 34 China 2003-2012 15 7 : 8 61 Yamaguchi et al 35 Japan n.r. 3 2 : 1 60 Yamamoto et al 36 Japan 1991-2009 13 10 : 3 64* Zhou et al 37 China If the Clavien-Dindo classification was not mentioned in reports, grades were assigned based on the information provided.…”

The Role of Venous and Arterial Resection in Pancreatic Cancer Surgery

“…One small study suggests that the need for reconstruction of the CHA may be determined by a significant ([25%) decrease in mean arterial pressure in the CHA after CA clamping. 71 The need for preoperative coiling or embolization of the CHA to improve collateral flow remains disputed. 72 In the 1970s, Nimura and colleagues from Japan incorporated celiac axis resection with distal pancreatectomy for pancreatic cancer and demonstrated improved survival compared with standard distal pancreatectomy.…”

Modified Appleby Procedure with Arterial Reconstruction for Locally Advanced Pancreatic Adenocarcinoma: A Literature Review and Report of Three Unusual Cases

“…Hirano et al performed preoperative embolization of the CHA and CA to promote collateralization to the hepatobiliary system via the pancreaticoduodenal arcade and stomach via right gastric, right gastroepipoloic, and the left phrenic arteries, respectively (Hirano 2007). Intraoperatively, if hepatic inflow appears to be insufficient as established via palpation, Doppler ultrasonography (Hirano 2007), hepatic vein oxygen saturation (Miyakawa 2002), fluorescein staining (Gagandeep 2006), or pre-and post-clamping common hepatic arterial stump pressures (Mittal 2015), then arterial reconstruction is necessary. Various approaches to vascular reconstruction have been described (Table 1).…”