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 radicalresection (R0) and in addition, an adequate and effective adjuvant therapy will berequired. We have performed radical operation including combined resection ofthe vessels, if necessary. On the other hand, to maintain the patient’s quality oflife and to adopt sufficient adjuvant therapy, we have also made effort to preserveorgan function as much as possible.In cases of pancreatic body and/or tail cancer, cancer often invades to the originof the common hepatic artery, the splenic artery or the celiac axis (CA). Forsuch cases, we performed “whole stomach-preserving distal pancreatectomy withcombined resection of the celiac axis (WSP-DP-CAR)” in 1987, and published asthe first report in 19911).In this procedure, the arterial blood supply to the whole stomach and the liver issecured only via the inferior pancreaticoduodenal artery arising from the superiormesenteric artery (SMA). So the bifurcation of the gastroduodenal artery (GDA)from the common hepatic artery must be safely preserved after strict evaluationwhether cancer invades to this site or not.The indications of this procedure should be applied to patients who diagnosed as1) no distant metastases, 2) no tumor involvement of the SMA and GDA and 3)resectable extrapancreatic nerve plexus invasion or lymph node metastases, andwill undergo pancreatectomy with curative intent.Since June 1987, we have performed this procedure to sixteen cases. For twocases, we were able to preserve the left gastric artery, and for five cases, theportal vein was resected and reconstructed. There were no severe postoperativecomplications, though delayed gastric emptying (DGE) in two cases, pancreaticfistula (Grade B ISGPF) in three cases were observed, and there was no problemwith the blood supply to the stomach and the liver. For ten cases, we obtainedcomplete resection (R0). Due to the good postoperative state, adjuvant therapycould be applied to all cases intended. Up to the end of July 2014, five patientsstill survive (four have no recurrences), eight patients lived more than oneyear (one year survival rate 69.6%), two patients lived more than five years,including one 205-months-survivor. Median survival time (MST) of all patientsis 18.8 months. There was no local recurrence except for only one non-curativeresection case due to the tumor invasion to the pancreatic cut margin.This procedure of WSP-DP-CAR has been safely performed and the postoperativecourse is almost same as that of standard distal pancreatectomy. We will performthis procedure because there is a chance that it may enhance local control andimprove survival of pancreatic cancer invading around the CA.I will present this procedure of WSP-DP-CAR, using the motion picture.