J.Jpn. Surg. Soc.. 120(4): 418-424, 2019

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Feature topic

TECHNICHAL TIPS ON DISTAL PANCREATECTOMY WITH EN BLOC CELIAC AXIS RESECTION AND SAFETY CONSIDERATIONS

Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) has been widely applied as a surgical technique for advanced pancreatic body or tail cancer. One of the features of the surgery is a dynamic switch of arterial blood flow in the biliary system and stomach due to resection of the celiac axis. Reflecting this feature, the morbidity rate after DP-CAR is high. Our institutional data from 80 consecutive cases of the procedure indicated that more than 40％ of patients suffered complications of Clavien-Dindo classification grade Ⅲ or higher postoperatively. In the DP-CAR procedure, surgeons are required to use sophisticated skills during dissection and division of the celiac axis at its origin from the aorta and preservation of the collateral arterial flow from the inferior pancreatoduodenal artery to the gastroduodenal artery. Regarding postoperative ischemic gastropathy, since preoperative occlusion of the common hepatic artery results in insufficient efficacy, reconstruction of the left gastric artery should be performed in patients with possible ischemia of the stomach. Because a recent study has revealed that preservation of the left inferior phrenic or left gastric artery could prevent the ischemia, preservation of these arteries should be considered when progression of the disease allows.

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