Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer.
OBJECTIVE
The 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.


METHODS
We 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.


RESULTS
The 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.


CONCLUSIONS
R0 operation with 3 different arterial reconstruction techniques was able to be performed without presenting any risk.
Amano
Hodaka
H
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga-cho, Itabashi-ku, Tokyo 173-8605, Japan. amano@med.teikyo-u.ac.jp
Miura
Fumihiko
F
Toyota
Naoyuki
N
Wada
Keita
K
Katoh
Ken-ichirou
K
Hayano
Kouichi
K
Kadowaki
Susumu
S
Shibuya
Makoto
M
Maeno
Sawako
S
Eguchi
Tomoaki
T
Takada
Tadahiro
T
Asano
Takehide
T
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011169:Portal Vein / Q000473:pathology; D013157:Splenic Artery / Q000601:surgery; D013270:Stomach / Q000098:blood supply