title: Distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR): common hepatic arterial stump pressure should determine the need for arterial reconstruction.
abstract: BACKGROUND
  Tumors arising in the neck and body of the pancreas often invade the common hepatic artery and celiac axis (CA), necessitating distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR). In these patients, the need for revascularization of the common hepatic artery (CHA) can be avoided on the basis of the pressure change in the CHA after clamping of the CA.
  
  
  METHODS
  All patients presenting to North Shore Hospital Campus of University of Sydney with advanced pancreatic malignancy of the neck and body between 2007 and 2014 were included in the study. The pressure in the CHA was measured pre- and postclamping of the CA; a decrease of more than 25% in the mean arterial pressure necessitated vascular reconstruction of the CHA.
  
  
  RESULTS
  Seven patients underwent a DPS-CAR between 2007 and 2014. Arterial reconstruction was required in 2 patients based on a decrease of >25% mean arterial pressure in the CHA after clamping the CA. There was no in hospital or 90-day mortality, and no patients developed ischemic hepatitis.
  
  
  CONCLUSIONS
  A single-stage DPS-CAR with selective arterial reconstruction based on the CHA pressure change after clamping the CA is a safe approach.
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Mittal
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Philip R
authors.initials: PR
authors.lastname: de Reuver
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Satya
authors.initials: S
authors.lastname: Shanbhag
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ralph F
authors.initials: RF
authors.lastname: Staerkle
authors.affiliation: Department of Vascular Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Neale
authors.affiliation: Department of Vascular Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Thoo
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hugh
authors.affiliation: Department of Anatomical Pathology, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia; Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia. Electronic address: jas.samra@bigpond.com.
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Samra
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D002445:Celiac Artery / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000502:physiology / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome; D058017:Vascular Grafting; D055815:Young Adult