Splenic Artery Reversal for Arterial Reconstructions in Locally Advanced Pancreatic Carcinoma

Abstract

Background: Splenic artery reversal (SAR) is a good option for arterial reconstructions in case of resections of common (CHA), proper ( PHA) hepatic or superior mesenteric (SMA) arteries for different reasons in different circumstances. This technique can be used in emergencies, so as electively before locally advanced tumour removal. Aim: To analyze the use of SAR for arterial reconstructions in locally advanced pancreatic carcinoma (LAPC). Method: retrospective study of morbidity, mortality and vessels patency in cases of SAR use for arterial reconstructions. Results: In 11 cases SAR was used for reconstruction of the SMA during resection of superior mesenteric vessels, and in 8 cases–for the reconstruction of the PHA during resection of the CHA. In 9 cases reconstruction was performed before LA tumour resection (8PDAC,1 NEN) and in two cases it was undertaken for bleeding from CHA or GDA stump 6 and 12 days after standard pancreatoduodenectomies. In 9 cases SAR was associated with total spleen-preserving pancreatectomy and in 2 cases with pancreatoduodenectomy. In all elective cases, portal/superior mesenteric veins were resected. One urgent patient died after rebleeding. Morbidity–54,5%(n6), POPF-0, lymphorrhea–36%(n4), bleeding-1, DGE–45%(n5). There were no liver or bowel ischemia and plasma lactate elevation during and after surgery. All the arterial anastomoses were patent 1-8 years after construction. Conclusion: SAR is a useful method for arterial reconstructions in locally advanced pancreatic carcinoma, which prevents liver and bowel ischemia during and after surgery and can be performed before tumour removal and to be spleen- and distal pancreas-preserving.