Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer. How I do It

Klompmaker, Sjors; Boggi, Ugo; Hackert, Thilo; Salvia, Roberto; Weiss, Matthew J.; Yamaue, Hiroki; Zeh, Herbert J.; Besselink, Marc G.

doi:10.1007/s11605-018-3894-7

Cited by 34 publications

(24 citation statements)

References 35 publications

(39 reference statements)

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“…In case of pancreatic body cancer with involvement of the celiac trunk, a distal pancreatectomy with celiac artery resection (DP-CAR or Appleby procedure) may be performed. We previously described the details of this procedure elsewhere [82]. DP-CAR combined with (neo)adjuvant therapy is associated with an 18–19 months overall survival, according to a recent systematic review and retrospective international series [83,84].…”

Section: Resultsmentioning

confidence: 99%

Locally Advanced Pancreatic Cancer: Work-Up, Staging, and Local Intervention Strategies

Veldhuisen¹,

Oord²,

Brada³

et al. 2019

Cancers

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Locally advanced pancreatic cancer (LAPC) has several definitions but essentially is a nonmetastasized pancreatic cancer, in which upfront resection is considered not beneficial due to extensive vascular involvement and consequent high chance of a nonradical resection. The introduction of FOLFIRINOX chemotherapy and gemcitabine-nab-paclitaxel (gem-nab) has had major implications for the management and outcome of patients with LAPC. After 4–6 months induction chemotherapy, the majority of patients have stable disease or even tumor-regression. Of these, 12 to 35% are successfully downstaged to resectable disease. Several studies have reported a 30–35 months overall survival after resection; although it currently remains unclear if this is a result of the resection or the good response to chemotherapy. Following chemotherapy, selection of patients for resection is difficult, as contrast-enhanced computed-tomography (CT) scan is unreliable in differentiating between viable tumor and fibrosis. In case a resection is not considered possible but stable disease is observed, local ablative techniques are being studied, such as irreversible electroporation, radiofrequency ablation, and stereotactic body radiation therapy. Pragmatic, multicenter, randomized studies will ultimately have to confirm the exact role of both surgical exploration and ablation in these patients. Since evidence-based guidelines for the management of LAPC are lacking, this review proposes a standardized approach for the treatment of LAPC based on the best available evidence.

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Section: Resultsmentioning

confidence: 99%

Locally Advanced Pancreatic Cancer: Work-Up, Staging, and Local Intervention Strategies

Veldhuisen¹,

Oord²,

Brada³

et al. 2019

Cancers

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“…We chose to perform preoperative CHA embolization to precondition the liver in arterial blood supply solely via the GDA, as is the rule in some centers [ 9 , 13 , 17 ]. Indeed, at exploration we found that the GDA was unusually wider and the blood flow through the PHA was normal.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, at exploration we found that the GDA was unusually wider and the blood flow through the PHA was normal. However, preoperative CHA embolization is not performed in several other high-volume pancreatic centers [ 13 ]. In a recent comparative study [ 7 ], no advantage was documented in 23 patients with CHA embolization before DP-CAR over 8 without.…”

Section: Discussionmentioning

confidence: 99%

“…When NAC is administered, median survival may increase to 2–3 years [ 3 , 7 , 9 ]. Because DP-CAR is only sporadically performed and individual experience is limited, an orchestrated international effort by highly respected pancreatic surgeons [ 13 ] was made, so that safe and evidence-based guidelines for the indications, contraindications, management algorithms, and technicalities for this operation can be formed for wider application.…”

Section: Introductionmentioning

confidence: 99%

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Distal pancreatectomy with celiac axis resection (DP-CAR): Optimal perioperative outcome in a patient with locally advanced pancreas adenocarcinoma

Tsiotos

Ballian

Milas

et al. 2020

International Journal of Surgery Case Reports

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Highlights DP-CAR: A rare, technically demanding operation with significant morbidity & mortality. DP-CAR may provide curative (R0) resection of an otherwise unresectable cancer. Our patient had optimal perioperative outcome and excellent histology result. To the best of our knowledge this is the first DP-CAR case in Greece.

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“…The procedure relies on the blood supply to PHA from GDA through the preserved pancreaticoduodenal arcade. This collateral channel can be made the dominant supply to biliary system, liver and pancreatic head by embolization of celiac origin and left gastric artery if deemed necessary .…”

Section: Pancreatic Surgerymentioning

confidence: 99%

Gastroduodenal artery: single key for many locks

Desai

Pande

2019

J Hepato Biliary Pancreat

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Gastroduodenal artery (GDA) commonly arises from common hepatic artery, a branch of celiac axis. It holds a unique anatomical position that connects the foregut and midgut due to its intimate communications with foregut and midgut arterial supply. Its numerous anatomical variations have a significant impact on planning and performance of hepatopancreaticobiliary (HPB) surgery. Its close relation to the first part of duodenum, common bile duct and head of pancreas makes it susceptible for inadvertent bleeding during or after surgery, or due to various HPB pathologies. Also, a large number of vascular interventions rely on GDA and its branches. Careful preoperative planning is the key and a detailed knowledge and awareness of its variant anatomy is of paramount importance, be it liver resections, liver transplant, biliary and pancreatic resections and pancreatic transplant or transarterial procedures involving these arteries. GDA can also be a cause of gastrointestinal hemorrhage due to true or pseudoaneurysms and anatomy has significant implications on its management. The article provides a succinct review on relevance of GDA anatomy and variations and highlights that preoperative planning and intraoperative awareness of variations is the key to performance of safe HPB surgery and interventions.

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Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer. How I do It

Cited by 34 publications

References 35 publications

Locally Advanced Pancreatic Cancer: Work-Up, Staging, and Local Intervention Strategies

Locally Advanced Pancreatic Cancer: Work-Up, Staging, and Local Intervention Strategies

Distal pancreatectomy with celiac axis resection (DP-CAR): Optimal perioperative outcome in a patient with locally advanced pancreas adenocarcinoma

Gastroduodenal artery: single key for many locks

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