title: A new surgical technique of pancreaticoduodenectomy with splenic artery resection for ductal adenocarcinoma of the pancreatic head and/or body invading splenic artery: impact of the balance between surgical radicality and QOL to avoid total pancreatectomy.
abstract: For pancreatic ductal adenocarcinoma (PDAC) of the head and/or body invading the splenic artery (SA), we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR). We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD) for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n=66) and PD-SAR (n=18). Most patients were treated by preoperative chemoradiotherapy (CRT). Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, P=0.538), despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Desaki
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tanemura
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kishiwada
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Azumi
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Kuriyama
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Usui
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy / Q000379:methods*; D013157:Splenic Artery / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate