Whole-stomach preserving distal pancreatectomy with combined resection of the celiac axis for advanced pancreatic body and/or tail cancer / Шинэ санаа Шинэ нээлт

ABSTRACT

For the treatment of pancreatic cancer, it is most important to perform radical resection (R0) and in addition, an adequate and effective adjuvant therapy will be required. We have performed radical operation including combined resection of the vessels, if necessary. On the other hand, to maintain the patient’s quality of life and to adopt sufficient adjuvant therapy, we have also made effort to preserve organ function as much as possible. In cases of pancreatic body and/or tail cancer, cancer often invades to the origin of the common hepatic artery, the splenic artery or the celiac axis (CA). For such cases, we performed “whole stomach-preserving distal pancreatectomy with combined resection of the celiac axis (WSP-DP-CAR)” in 1987, and published as the first report in 19911). In this procedure, the arterial blood supply to the whole stomach and the liver is secured only via the inferior pancreaticoduodenal artery arising from the superior mesenteric artery (SMA). So the bifurcation of the gastroduodenal artery (GDA) from the common hepatic artery must be safely preserved after strict evaluation whether cancer invades to this site or not. The indications of this procedure should be applied to patients who diagnosed as 1) no distant metastases, 2) no tumor involvement of the SMA and GDA and 3) resectable extrapancreatic nerve plexus invasion or lymph node metastases, and will undergo pancreatectomy with curative intent. Since June 1987, we have performed this procedure to sixteen cases. For two cases, we were able to preserve the left gastric artery, and for five cases, the portal vein was resected and reconstructed. There were no severe postoperative complications, though delayed gastric emptying (DGE) in two cases, pancreatic fistula (Grade B ISGPF) in three cases were observed, and there was no problem with the blood supply to the stomach and the liver. For ten cases, we obtained complete resection (R0). Due to the good postoperative state, adjuvant therapy could be applied to all cases intended. Up to the end of July 2014, five patients still survive (four have no recurrences), eight patients lived more than one year (one year survival rate 69.6%), two patients lived more than five years, including one 205-months-survivor. Median survival time (MST) of all patients is 18.8 months. There was no local recurrence except for only one non-curative resection case due to the tumor invasion to the pancreatic cut margin. This procedure of WSP-DP-CAR has been safely performed and the postoperative course is almost same as that of standard distal pancreatectomy. We will perform this procedure because there is a chance that it may enhance local control and improve survival of pancreatic cancer invading around the CA. I will present this procedure of WSP-DP-CAR, using the motion picture.