Common hepatic artery embolization is an unnecessary procedure before DP CAR. Experience of 40 surgeries without arterial reconstructions

Abstract

Background: Distal pancreatectomy with celiac artery (CA) resection (DPCAR) is an option for borderline resectable pancreatic body cancer. It is believed that the reduction of arterial blood supply after DPCAR may cause severe liver ischemia. Decision to embolize preoperatively or reconstruct common hepatic artery (СHA) during DPCAR is under discussion. Aim: To assess postDPCAR events: Primary: liver arterial supply, arterial blood flow intensity (BFI) through the pancreaticoduodenal (PDA), gastroduodenal (GDA) and proper hepatic (PHA) arteries. Secondary: morbidity, 90-days mortality,pancreatic fistulas B/C, OS, DFS. Patients and methods: Arterial anatomy, diameters of CHA, PDA, GDA and PHA were registered before and after 40 DP CARs by CT. IOUS (40) and ICG–gastroscopy (10) were ischemia assessment tools. Preoperative CHA embolization was never used. Results: Among 52 CA resections 12 procedures were excluded because of GDA involvement and necessity for total duodenopancreatectomy/arterial reconstruction. In all 40 residuary cases of DPCAR arterial flow in liver parenchyma was preserved and there were no CHA reconstructions. GDA, PDA and PHA BFI increased in 0,71-90 times after DPCAR, BFI in PHA didn’t change significantly after surgery. Gastric ischemia was revealed in 4 and liver ischemia in 0 cases. R0 -resection was achieved in 36 (90%) cases. Chemotherapy for PDAC(31) was neoadjuvant (11) and adjuvant (16). Morbidity-57,5%, B/Cfistulas-8 (20%), mortality-3 (7,5%), OS-30 months, DFS-16 months, Three and 5-year survival were 83%,43% and 41%, Actual 5-y OS -19.5%. Conclusion: As CHA reconstruction, so as its preoperative occlusion are unnecessary procedures for DPCAR. IOUS is a reliable method for liver ischemia assessment during DPCAR, which is less frequent event than gastric ischemia.