title: Alternative arterial reconstruction after extended pancreatectomy. Case report and some considerations of locally advanced pancreatic cancer.
abstract: BACKGROUND
  The clinical benefits of distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer remains controversial and, therefore, declared unresectable in most cases. Appleby first described extended distal pancreatectomy with celiac axis resection for locally advanced gastric cancer.
  
  
  METHODS
  We report a case of a 65-year-old female who presented a locally advanced pancreatic carcinoma with infiltration of celiac axis. After radio-chemo neoadjuvant treatment, the patient underwent exploratory laparoscopy and subsequent distal pancreatectomy with en bloc resection of celiac axis. Arterial reconstruction was necessary as hepatic flow was not adequate, determined by intraoperative Doppler ultrasonography. It consisted of end to end anastomosis with prosthetic graft between hepatic artery directly to the aorta, as an atheromatous plaque was at the origin of the celiac axis. The postoperative course was uneventful with a perfect relief of pain. She presents a long term survival of 36 months, very exceptional for this type of disease.
  
  
  CONCLUSIONS
  The particularity of this case is not only the surgical treatment, rarely offered to these patients, but also and especially the subsequent vascular reconstruction. To our knowledge, this is the first report of this type of arterial reconstruction. Besides, we briefly discuss the recent advances in results of extended distal pancreatectomy with arterial resection for locally advanced pancreatic carcinoma.
authors.affiliation: General Surgery Department, Madrid Sanchinarro University Hospital, San Pablo University. Madrid, Spain. ielpo.b@gmail.com
authors.forename: Benedetto
authors.initials: B
authors.lastname: Ielpo
authors.forename: Valentina
authors.initials: V
authors.lastname: Ferri
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caruso
authors.forename: Hipolito
authors.initials: H
authors.lastname: Duran
authors.forename: Eduardo
authors.initials: E
authors.lastname: Diaz
authors.forename: Isabel
authors.initials: I
authors.lastname: Fabra
authors.forename: Catalina
authors.initials: C
authors.lastname: Oliva
authors.forename: Sergio
authors.initials: S
authors.lastname: Olivares
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Quijano
authors.forename: Emilio
authors.initials: E
authors.lastname: Vicente
mesh_terms: D000368:Aged; D001158:Arteries / Q000601:surgery*; D002445:Celiac Artery / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome