title: Combined hepatic arterial resection in pancreatic resections for locally advanced pancreatic cancer.
abstract: OBJECTIVE
  Arterial involvement in advanced pancreatic cancer generally defines local unresectability. This study was aimed to evaluate the clinical outcomes of combined common hepatic arterial resection with pancreaticoduodenectomy or total pancreatectomy in patients with locally advanced pancreatic cancer involving the hepatic artery.
  
  
  METHODS
  Of 348 patients with pancreatic head cancers who underwent surgical resection between June 1999 and September 2015, 21 underwent combined common hepatic arterial resection with pancreaticoduodenectomy (17) or total pancreatectomy (4). Preoperative common hepatic arterial embolization was performed in 12 patients. Preoperative CT findings of hepatic arterial involvement, postoperative complications, survival rates, and prognostic factors for survival were analyzed. Twenty-one unresectable patients with locally advanced pancreatic cancer who underwent laparotomy in this study period were selected as the control group.
  
  
  RESULTS
  Rates of pathological arterial invasion were significantly higher in patients with level III (>1800) CT findings (90%,9/10) than in patients with levels I and II (<1800) (27%, 3/11) (p < 0.01). No surgical deaths occurred. Survival after surgical resection in all 21 patients was 47.6%, 6.6%, and 6.6% at 1, 3, and 5 years, and median survival was 11 months. The preoperative serum CA19-9 level was a significant prognostic factor for overall survival, median survivals were 21.5 and 8.3 months in the low CA19-9 and high CA19-9 groups, respectively. No significant difference in survival between the high-CA19-9 group and the unresectable group was found.
  
  
  CONCLUSIONS
  Combined common hepatic arterial resection in pancreaticoduodenectomy or total pancreatectomy might be feasible with an acceptable rate of surgical complications, and may have a beneficial effect on the prognosis only in patients with low preoperative serum CA19-9 levels.
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan. masaru@faculty.chiba-u.jp.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Shigetsugu
authors.initials: S
authors.lastname: Takano
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: International University of Health & Welfare Mita Hospital, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Katunori
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takayashiki
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuboki
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-0856, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D015996:Survival Rate
keywords: Arterial resection; Hepatic arterial resection; Pancreas head cancer; Pancreatic resection