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 IIb
31 International Union
32 MethodsWe
33 PV reconstruction
34 RLHA
35 ResultsThe mean operating time
36 Union
37 advanced pancreatic cancer
38 anastomosis
39 angiography
40 arterial reconstruction
41 arterial reconstruction technique
42 arterial structure
43 artery
44 artery thrombosis
45 biliary fistula
46 blood loss
47 cancer
48 cancer stage
49 candidates
50 cases
51 caudal side
52 common hepatic artery
53 complex vascular reconstruction
54 complications
55 computed tomography angiography
56 curative resection
57 different techniques
58 end
59 end anastomosis
60 failure
61 fistula
62 gastric artery
63 gastroepiploic artery
64 head
65 hepatic artery
66 hepatic artery thrombosis
67 individual cases
68 infection
69 invasion
70 involvement
71 left gastric artery
72 left hepatic artery
73 liver failure
74 loss
75 mean blood loss
76 mean operating time
77 middle hepatic artery
78 min
79 operating time
80 operation
81 pancreas
82 pancreas head
83 pancreatectomy
84 pancreatic cancer
85 patency
86 portal vein invasion
87 reconstruction
88 reconstruction technique
89 relationship
90 resectability
91 resection
92 right gastroepiploic artery
93 right hepatic artery
94 rights
95 risk
96 serious complications
97 side
98 side anastomosis
99 splenic artery
100 stage
101 structure
102 surgery
103 technique
104 three-dimensional computed tomography angiography
105 thrombosis
106 time
107 tomography angiography
108 tumors
109 vascular reconstruction
110 vein invasion
111 wound infection
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