Distal Pancreatectomy With En Bloc Resection of the Celiac Trunk for Extended Pancreatic Tumor Disease: An Interdisciplinary Approach

Journal Article · Sat Oct 15 04:00:00 EDT 2011 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-010-9997-5· OSTI ID:21608575

Denecke, Timm ^[1]; Andreou, Andreas ^[2]; Podrabsky, Petr; Grieser, Christian ^[1]; Warnick, Peter; Bahra, Marcus; Klein, Fritz ^[2]; Hamm, Bernd ^[1]; Neuhaus, Peter; Glanemann, Matthias ^[2]

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1. Charite-Universitaetsmedizin Berlin, Klinik fuer Strahlenheilkunde (Germany)
2. Charite-Universitaetsmedizin Berlin, Klinik fuer Allgemein-, Viszeral-, und Transplantationschirurgie (Germany)

Purpose: Infiltration of the celiac trunk by adenocarcinoma of the pancreatic body has been considered a contraindication for surgical treatment, thus resulting in a very poor prognosis. The concept of distal pancreatectomy with resection of the celiac trunk offers a curative treatment option but implies the risk of relevant hepatic or gastric ischemia. We describe initial experiences in a small series of patients with left celiacopancreatectomy with or without angiographic preconditioning of arterial blood flow to the stomach and the liver. Materials and Methods: Between January 2007 and October 2009, six patients underwent simultaneous resection of the celiac trunk for adenocarcinoma of the pancreatic body involving the celiac axis. In four of these cases, angiographic occlusion of the celiac trunk before surgery was performed to enhance collateral flow from the gastroduodenal artery. Radiologic and surgical procedures, findings, and outcome were analyzed retrospectively. Results: Complete tumor removal (R0) succeeded in two patients, whereas four patients underwent R1-tumor resection. After surgery, one of the two patients without angiographic preparation experienced an ischemic stomach perforation 1 week after surgery. The other patient died from severe bleeding from an ischemic gastric ulcer. Of the four patients with celiac trunk embolization, none presented ischemic complications after surgery. Mean survival was 371 days. Conclusion: In this small series, ischemic complications after celiacopancreatectomy occurred only in those patients who did not receive preoperative celiac trunk embolization.

• OSTI ID: 21608575
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 5 Vol. 34; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANEMIAS
ARTERIES
BLOOD FLOW
BLOOD VESSELS
BODY
CARCINOMAS
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
DIGESTIVE SYSTEM
DISEASES
ENDOCRINE GLANDS
GLANDS
HAZARDS
HEMIC DISEASES
ISCHEMIA
LIVER
MATERIALS
MEDICINE
NEOPLASMS
ORGANS
PANCREAS
PATHOLOGICAL CHANGES
PATIENTS
SURGERY
SYMPTOMS
ULCERS
VASCULAR DISEASES