Iliac–hepatic arterial bypass for compromised collateral flow during modified Appleby operation for advanced pancreatic cancer

Distal Pancreatectomy for Body-Tail Pancreatic Cancer: Is There a Role for Celiac Axis Resection?

“…We performed a tangential resection of the portal vein in one of our 5 patients, as in 31/78 patients (39.7%) reported in the literature [7,8,9,10,11,12,13,14,15,16,18,19,20,21,22,24,25,26,28]. The mortality rate after combined CA and portal vein resection was 2/31 patients (6.5%), while it was 0/47 patients after CA resection alone; thus, associating portal vein resection with DP-CAR increases the related mortality rate.…”

“…In our experience, one of the main achievements of DP-CAR was the control of severe pain in all 5 patients. Unfortunately, many authors do not report on their patients’ pain [7,8,9,11,12,15,16,17,20,22,23,24,26], while complete, or near-complete pain relief was achieved in 24 of 25 patients (96%) mentioned in reports dealing with this aspect [10,13,14,18,19,21,25,27,28] (table 2). …”

“…After the first DP-CAR for body-tail pancreatic cancer performed by Nimura et al [7] in 1976, only 90 patients emerged from a careful literature review [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28] (table 2). Since there are no large series of DP-CAR for pancreatic cancer, we pooled our own findings with published reports in an attempt to draw some conclusions about the related surgical risk and long-term results.…”

“…Proper hepatic artery blood flow after CA and CHA clamping can be assessed by palpation, by monitoring hepatic venous hemoglobin oxygen saturation [12], by Doppler ultrasound [21], or by fluorescein test with Wood’s lamp [25]. If inadequate, the arterial blood flow was reconstructed by reimplantation of the CHA or left gastric artery to celiac trunk [16,25], or by arterial [11,18,27,28] or vein [12,23,27] grafts in one of our patients and 13/74 patients (17.6%) reported in the literature. If the surgical risk related to the DP-CAR is considered excessive, the procedure should be abandoned [15,19].…”

“…Nimura et al [7] performed the first DP-CAR in a patient with body-tail pancreatic cancer in 1976. To date, DP-CAR for the surgical treatment of body-tail pancreatic cancer has been reported in a limited number of patients, mainly by Far Eastern authors [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22], while experience with this operation in Western countries is limited and more recent [23,24,25,26,27,28]. The indication for DP-CAR was recently extended to patients without any direct invasion of the CA to increase the radical resection (R0) rate for advanced body-tail pancreatic cancer [18].…”