Resection of the celiac axis for invasive pancreatic cancer.
Pancreatic cancer arising in the neck or body of the gland frequently presents at a more advanced stage compared with tumors arising in the pancreatic head. Vascular invasion into the celiac axis is a common contraindication to surgical resection. We report an en bloc pancreatectomy, splenectomy, and total gastrectomy with resection of the celiac axis for a pancreatic body adenocarcinoma invading the celiac axis and posterior stomach. Collateral blood flow to the liver via the gastroduodenal artery was initially identified on preoperative computed tomography (CT) imaging and confirmed intraoperatively with vascular testing before resection. One of 14 regional lymph nodes was positive for malignancy, and surgical margins were free of tumor. The patient's postoperative course was unremarkable. En bloc resection of the celiac axis and hepatic artery may be safely performed in select patients with localized pancreatic cancer invading these vessels.
Makary
Martin A
MA
Departments of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. mmakary1@jhmi.edu
Fishman
Elliot K
EK
Cameron
John L
JL
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed