Distal Pancreatectomy With En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Body Cancer

Abstract

DP-CAR offers a high R0 resectability rate and may potentially achieve complete local control in selected patients. The persisting early hepatic recurrence may indicate DP-CAR for the treatment of less advanced disease.

Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: a single institutional assessment of perioperative outcomes and survival

“…Since then, sporadic reports on the safety and feasibility of DP-CAR have emerged, albeit in small numbers and in the absence of long-term data on survival. [12][13][14][15][16][17] Recent reports have highlighted a potential increase in morbidity and mortality following DP-CAR. 18 In an attempt to curb the postoperative morbidity of pancreatic resections, we have expanded the application of minimally invasive approaches to include resections of locally advances pancreatic body/tail tumors.…”

Generation and Impact of Neural Invasion in Pancreatic Cancer

“…Importantly, a common denominator of these studies on "en bloc" resection of retropancreatic neural plexus is the pronounced pain relief as a result of the resection of celiac plexus (Kondo et al, 2001;Hirano et al, 2007). This deciding association between extrapancreatic neural plexus and pain sensation builds up the link to the concept of "pancreatic neuropathy" in PCa which encompasses NI and several other neural alterations in PCa , as explained in the following section.…”

“…However, these studies mostly concentrated on more extensive lymphadenectomy rather than plexus resection as the actual measure to reduce NI. In further newer studies Sperti et al, ;Kondo et al, 2001;Hirano et al, 2007;Chakravarty et al, 2011), the feasibility and safety of an en bloc resection including celiac artery, plexus and ganglia was demonstrated, but the actual survival beneift from this Fig. 1.…”

Should We Perform Arterial Embolization Before Distal Pancreatectomy Combined with En Bloc Resection of the Celiac Axis for Locally Advanced Pancreatic Cancer?

“…The DP-CAR procedure included en bloc resection of the celiac, common hepatic, and left gastric arteries; the celiac plexus and ganglia; the nerve plexus around the superior mesenteric artery; part of the crus of the diaphragm; the Gerota fascia; the left adrenal gland; the retroperitoneal fat tissue containing lymph nodes above the left renal vein; the part of the transverse mesocolon covering the body of the pancreas; and the inferior mesenteric vein. Resection of the portal vein and the middle colic vessels was considered optional [5] (Figure 1). On the other hand, in the DP procedure the celiac, common hepatic, and left gastric arteries were preserved, but the other procedures were the same as those performed during DP-CAR.…”

“…Locally advanced cancer of the body or tail of the pancreas used to be considered to be unresectable as it often invades the celiac axis and the surrounding nerve plexus. Since extended distal pancreatectomy combined with en bloc resection of the celiac axis (DP-CAR) for locally advanced pancreatic cancer was developed [2] and reported [3], it has become one of the treatments of choice for locally advanced cancer of the body or tail of the pancreas at high volume centers for hepatobiliary/pancreatic surgery [4][5][6][7][8]. Preoperative embolization of the left gastric artery and/or common hepatic artery is often performed prior to DP-CAR to prevent ischemic complications, but its effectiveness is unclear.…”