Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-10-10

AUTHORS

Hodaka Amano, Fumihiko Miura, Naoyuki Toyota, Keita Wada, Ken-ichirou Katoh, Kouichi Hayano, Susumu Kadowaki, Makoto Shibuya, Sawako Maeno, Tomoaki Eguchi, Tadahiro Takada, Takehide Asano

ABSTRACT

Background/purposeThe resectability of locally advanced pancreatic cancer depends upon, before anything else, the relationship between the tumor and the adjacent arterial structure. Pancreatic cancer that has developed at the caudal side of the pancreas can invade the common hepatic artery (CHA). Pancreatic cancers with CHA involvement can become candidates for surgery in selected cases. Pancreatic cancer arising at the caudal side of the pancreas head may sometimes invade the right and left hepatic arteries (RLHA) as well as the CHA. Pancreatic cancer with RLHA involvement may be assessed as unresectable unless complex vascular reconstruction is performed.MethodsWe have experienced 3 cases of successfully resected pancreatic cancer with RLHA and portal vein (PV) invasion. Pancreatectomy (including total pancreatectomy in two cases and pancreatoduodenectomy in one case) with RLHA and PV reconstruction was performed. Three different techniques of arterial reconstruction that were suitable for the individual cases were used. They were: (1) end-to-end anastomosis between the CHA and the left hepatic artery (LHA) and end-to-end anastomosis between the middle hepatic artery (MHA) and the right hepatic artery (RHA), (2) end-to-end anastomosis between the left gastric artery (LGA) and the RHA and end-to-end anastomosis between the right gastroepiploic artery and the LHA, and (3) end-to-side anastomosis between the splenic artery (SA) and the LHA and end-to-end anastomosis between the SA and the RHA.ResultsThe mean operating time was 735 min (range 686–800 min) and the mean blood loss was 1726 ml (range 1140–2230 ml). Microscopic curative resection (R0) was possible in all cases even if their International Union Against Cancer (UICC) stage was IIb. There was one case of wound infection, although no serious complications, including hepatic artery thrombosis, liver failure, or biliary fistula were observed. By follow-up three-dimensional computed tomography (3D-CT) angiography, the patency of the anastomosed artery was confirmed to be maintained in all three cases.ConclusionsR0 operation with 3 different arterial reconstruction techniques was able to be performed without presenting any risk. More... »

PAGES

777

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00534-009-0202-7

DOI

http://dx.doi.org/10.1007/s00534-009-0202-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1000728857

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19820892


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    "description": "Background/purposeThe resectability of locally advanced pancreatic cancer depends upon, before anything else, the relationship between the tumor and the adjacent arterial structure. Pancreatic cancer that has developed at the caudal side of the pancreas can invade the common hepatic artery (CHA). Pancreatic cancers with CHA involvement can become candidates for surgery in selected cases. Pancreatic cancer arising at the caudal side of the pancreas head may sometimes invade the right and left hepatic arteries (RLHA) as well as the CHA. Pancreatic cancer with RLHA involvement may be assessed as unresectable unless complex vascular reconstruction is performed.MethodsWe have experienced 3 cases of successfully resected pancreatic cancer with RLHA and portal vein (PV) invasion. Pancreatectomy (including total pancreatectomy in two cases and pancreatoduodenectomy in one case) with RLHA and PV reconstruction was performed. Three different techniques of arterial reconstruction that were suitable for the individual cases were used. They were: (1) end-to-end anastomosis between the CHA and the left hepatic artery (LHA) and end-to-end anastomosis between the middle hepatic artery (MHA) and the right hepatic artery (RHA), (2) end-to-end anastomosis between the left gastric artery (LGA) and the RHA and end-to-end anastomosis between the right gastroepiploic artery and the LHA, and (3) end-to-side anastomosis between the splenic artery (SA) and the LHA and end-to-end anastomosis between the SA and the RHA.ResultsThe mean operating time was 735\u00a0min (range 686\u2013800\u00a0min) and the mean blood loss was 1726\u00a0ml (range 1140\u20132230\u00a0ml). Microscopic curative resection (R0) was possible in all cases even if their International Union Against Cancer (UICC) stage was IIb. There was one case of wound infection, although no serious complications, including hepatic artery thrombosis, liver failure, or biliary fistula were observed. By follow-up three-dimensional computed tomography (3D-CT) angiography, the patency of the anastomosed artery was confirmed to be maintained in all three cases.ConclusionsR0 operation with 3 different arterial reconstruction techniques was able to be performed without presenting any risk.", 
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23 schema:description Background/purposeThe resectability of locally advanced pancreatic cancer depends upon, before anything else, the relationship between the tumor and the adjacent arterial structure. Pancreatic cancer that has developed at the caudal side of the pancreas can invade the common hepatic artery (CHA). Pancreatic cancers with CHA involvement can become candidates for surgery in selected cases. Pancreatic cancer arising at the caudal side of the pancreas head may sometimes invade the right and left hepatic arteries (RLHA) as well as the CHA. Pancreatic cancer with RLHA involvement may be assessed as unresectable unless complex vascular reconstruction is performed.MethodsWe have experienced 3 cases of successfully resected pancreatic cancer with RLHA and portal vein (PV) invasion. Pancreatectomy (including total pancreatectomy in two cases and pancreatoduodenectomy in one case) with RLHA and PV reconstruction was performed. Three different techniques of arterial reconstruction that were suitable for the individual cases were used. They were: (1) end-to-end anastomosis between the CHA and the left hepatic artery (LHA) and end-to-end anastomosis between the middle hepatic artery (MHA) and the right hepatic artery (RHA), (2) end-to-end anastomosis between the left gastric artery (LGA) and the RHA and end-to-end anastomosis between the right gastroepiploic artery and the LHA, and (3) end-to-side anastomosis between the splenic artery (SA) and the LHA and end-to-end anastomosis between the SA and the RHA.ResultsThe mean operating time was 735 min (range 686–800 min) and the mean blood loss was 1726 ml (range 1140–2230 ml). Microscopic curative resection (R0) was possible in all cases even if their International Union Against Cancer (UICC) stage was IIb. There was one case of wound infection, although no serious complications, including hepatic artery thrombosis, liver failure, or biliary fistula were observed. By follow-up three-dimensional computed tomography (3D-CT) angiography, the patency of the anastomosed artery was confirmed to be maintained in all three cases.ConclusionsR0 operation with 3 different arterial reconstruction techniques was able to be performed without presenting any risk.
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30 schema:keywords Background/purposeThe resectability
31 CHA involvement
32 ConclusionsR0 operation
33 IIb
34 International Union
35 MethodsWe
36 Microscopic curative resection
37 PV reconstruction
38 RLHA involvement
39 ResultsThe mean operating time
40 Union
41 adjacent arterial structure
42 advanced pancreatic cancer
43 anastomosis
44 angiography
45 arterial reconstruction
46 arterial reconstruction technique
47 arterial structure
48 artery
49 artery thrombosis
50 biliary fistula
51 blood loss
52 cancer
53 cancer stage
54 candidates
55 cases
56 caudal side
57 common hepatic artery
58 complex vascular reconstructions
59 complications
60 computed tomography angiography
61 curative resection
62 different arterial reconstruction techniques
63 different techniques
64 end
65 end anastomosis
66 failure
67 fistula
68 gastric artery
69 gastroepiploic artery
70 head
71 hepatic artery
72 hepatic artery thrombosis
73 individual cases
74 infection
75 invasion
76 involvement
77 left gastric artery
78 left hepatic artery
79 liver failure
80 loss
81 mean blood loss
82 mean operating time
83 middle hepatic artery
84 min
85 operating time
86 operation
87 pancreas
88 pancreas head
89 pancreatectomy
90 pancreatic cancer
91 patency
92 portal vein invasion
93 purposeThe resectability
94 rLHa
95 reconstruction
96 reconstruction technique
97 relationship
98 resectability
99 resection
100 right gastroepiploic artery
101 right hepatic artery
102 rights
103 risk
104 serious complications
105 side
106 side anastomosis
107 splenic artery
108 stage
109 structure
110 surgery
111 technique
112 three-dimensional computed tomography angiography
113 thrombosis
114 time
115 tomography angiography
116 tumors
117 vascular reconstruction
118 vein invasion
119 wound infection
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