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Important technical remarks on distal pancreatectomy with en-bloc celiac axis resection for locally advanced pancreatic body cancer (with video)

Abstract

Background

We have already reported the feasibility, safety, and excellent long-term results of distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) for locally advanced pancreatic body cancer. An international standard for the surgical technique of DP-CAR has yet to be established.

Methods

DP-CAR was carefully performed in 42 patients in Hokkaido University Hospital from 1998 to July 2007. Arterial blood flow alteration and collateral flow development toward the liver and stomach was obtained following preoperative routine transcatheter arterial embolization of the common hepatic artery. The right-sided approach to the superior mesenteric artery and celiac artery, and the preservation of the inferior pancreatoduodenal artery during the dissection of the plexus around the pancreatic head, are the key techniques in DP-CAR.

Results

The operative morbidity and mortality were 43 and 4.8%, respectively. R0 resection could be done in 39 (93%) patients. Median operation time and intraoperative blood loss were 478 min and 1030 ml, respectively. Ischemic gastropathy was complicated in 5 (12%) patients, but liver abscess was found in only one patient and no liver failure was encountered.

Conclusions

We emphasize again the feasibility and safety of DP-CAR; it should be a treatment of choice for locally advanced pancreatic body cancer.

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Acknowledgments

We sincerely thank the leadership of our boss, Prof. Satoshi Kondo, who passed away due to lung cancer. He will live on in our hearts, and we must make guarantee his belief that surgeons maintain an undiminishing, ever-expanding desire for the cure of their patients.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Eiichi Tanaka.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Surgical technique of the right sided approach was shown in the video. Detailed was written in the text (MPG 9616 kb)

Surgical technique of the retroperitoneal eradication was shown in the video. Detailed was written in the text (MPG 6044 kb)

Surgical technique of the plexus division was shown in the video. Detailed was written in the text (MPG 9982 kb)

Surgical technique of the right sided approach was shown in the video. Detailed was written in the text (MPG 9616 kb)

Surgical technique of the retroperitoneal eradication was shown in the video. Detailed was written in the text (MPG 6044 kb)

Surgical technique of the plexus division was shown in the video. Detailed was written in the text (MPG 9982 kb)

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Tanaka, E., Hirano, S., Tsuchikawa, T. et al. Important technical remarks on distal pancreatectomy with en-bloc celiac axis resection for locally advanced pancreatic body cancer (with video). J Hepatobiliary Pancreat Sci 19, 141–147 (2012). https://doi.org/10.1007/s00534-011-0473-7

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Keywords

  • Distal pancreatectomy with en-bloc celiac axis resection (DP-CAR)
  • Stomach preservation
  • Extended pancreatic resection
  • Modified Appleby operation