title: [A Case of Successful Stomach-Preserving Pancreaticoduodenectomy with Celiac Artery Resection after Neoadjuvant Chemoradiation Therapy for Pancreatic Cancer with Hepatic Arterial Variation].
abstract: Here we report a case of successful stomach-preserving pancreaticoduodenectomy with celiac artery resection for pancreatic cancer with hepatic arterial variation. A 70-year-old woman was referred to our hospital for examination and treatment of pancreatic cancer. A CT scan showed a tumor with suspected portal vein invasion at the body and head of the pancreas, in contact with the common hepatic artery and the splenic artery with 360°involvement. Contact with the celiac artery and left gastric artery was less than1 80°. CT and angiography revealed hepatic arterial variation in which the right hepatic artery and the left hepatic artery arose from the superior mesenteric artery and the left gastric artery, respectively. Resectability status was considered as borderline resectable. After neoadjuvant chemoradiation therapy, the levels of the serum tumor markers declined remarkably and a CT scan showed SD(RECIST). Subtotal stomach-preserving pancreaticoduodenectomy with celiac artery resection(SSPPD-CAR)was performed without resectionof the left gastric artery and a pathological R0 resectionwas achieved. The significance of performing combination resection and reconstruction of a major artery in pancreatic cancer is unclear. However, there may be cases with vascular variants that enable radical resection without reconstruction of the common hepatic artery. Therefore, it is important to preoperatively evaluate the configuration of the artery accurately and to select the optimal surgical procedures onthe basis of these variations.
authors.affiliation: Dept. of Surgery, Tohoku University Graduate School of Medicine.
authors.forename: Yukie
authors.initials: Y
authors.lastname: Kyakumoto
authors.forename: Masamichi
authors.initials: M
authors.lastname: Mizuma
authors.forename: Tomoya
authors.initials: T
authors.lastname: Abe
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Takadate
authors.forename: Koji
authors.initials: K
authors.lastname: Fukase
authors.forename: Hideo
authors.initials: H
authors.lastname: Otsuka
authors.forename: Naoaki
authors.initials: N
authors.lastname: Sakata
authors.forename: Kei
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Takanori
authors.initials: T
authors.lastname: Morikawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Naitoh
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kanno
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002445:Celiac Artery / Q000601:surgery*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004338:Drug Combinations; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D020360:Neoadjuvant Therapy; D010094:Oxonic Acid / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D005641:Tegafur / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine