Surgical strategy for patients with pancreatic body/tail carcinoma: Who should undergo distal pancreatectomy with en-bloc celiac axis resection?

Pancreatectomy with major arterial resection after neoadjuvant chemoradiotherapy gemcitabine and S-1 and concurrent radiotherapy for locally advanced unresectable pancreatic cancer

“…The aim of preoperative arterial embolization of the CHA, splenic artery, and left gastric artery was to minimize ischemic gastropathy and hepatopathy after CA resection in DP-CAR and TP-CAR+CHAR. 5,6 The embolization was performed $14 days after completion of CRT and 10 days before a planned pancreatectomy with major arterial resection. After embolization, the gastric and hepatic blood inflow through the pancreatoduodenal arcade and gastroduodenal artery from the SMA and the development of collateral circulation from the right subphrenic artery were observed 3 days before operation.…”

“…[4][5][6][7] The Japan Pancreatic Society analyzed 743 patients who underwent pancreatoduodenectomy (PD) for PC invading to the major artery and found that pancreatectomy with major arterial resection had no survival benefit; the median survival time and 5-year survival rate of patients who underwent PD with major arterial resection were 8 months and 3%, respectively, whereas those without arterial resection were 9 months and 4%, respectively. 8 Although this result was derived from a retrospective analysis, major arterial resection by itself may not contribute to prolonging the survival of cases of PC with arterial invasion.…”

Left Gastric Artery Reconstruction after Distal Pancreatectomy with Celiac Axis En-Bloc Resection: How We Do It

“…Patients whose LGA does not branch antecedently or who have a distance of <10 mm between the LGA and a tumor undergo LGA-resecting DP-CAR in our institution in order to avoid R1 curability [2] . The distance between the tumor and the LGA was measured by multidetector row computed tomography prior to surgery.…”

“…In 2014, we introduced preservation of the left gastric artery (LGA) on the basis of anatomical features in patients undergoing distal pancreatectomy with celiac axis en-bloc resection (DP-CAR) [1][2][3] . Although favorable results of DP-CAR in terms of avoiding ischemic gastropathy have been reported [4] , delayed gastric emptying and ischemic gastropathy after LGA-resecting DP-CAR remain a persistent problem [4,5] .…”

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

“…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.…”