Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) with Preoperative Embolization of CHA (Common Hepatic Artery). Experience from a High-Volume Center

Abstract

Background: Surgery is the only potential curative treatment of PDAC (pancratic ductal adenocarcinoma). When tumor is located in the body and/or tail of the pancreas and involves the CHA and/or CA (celiac axis/trunc) tumor has until recently been considered unresectable. Distal pancreatectomy with en bloc resection of the celiac axis (DP-CAR) may be an option to achieve R0 resection. To enhance collateral arterial supply for the liver and stomach, preoperative embolization of the CHA with operation two weeks later may be indicated. Methods: Patients with locally advanced tumors in the body and/or tail of pancreas were evaluated for DP-CAR procedures with preoperative embolization of CHA and in some cases left gastric artery (LGA) if involved in tumor. Patients with tumors involving GDA (gastroduodenal artery) or central (<2cm) of the CT (celiac trunc) and patients with metastatic disease (M1) were not included. Results: From May 2013 to Juli 2021 a total of 29 patients went through DP-CAR with preoperative embolization. We did not record any adverse events related to the preoperative embolization of CHA. Patients had longer postoperative hospitalization, but no difference in major complications, including pancreatic fistulas, when compared to our standard distal pancreatectomies. Conclusion: Preoperative embolization is feasible and may in be a good option as preparation for DP-CAR. In high-volume centers DP-CAR can be performed with outcomes comparable to standard distal pancreatectomies.