The clinical impact of left gastric artery reconstruction/preservation during distal pancreatectomy with celiac axis resection for pancreatic body cancer

Abstract

Background: For locally advanced pancreatic body cancer with contact to or close to the celiac axis, distal pancreatectomy with celiac axis resection (DP-CAR) is necessary to achieve R0 resection, and also postoperative adjuvant chemotherapy is important. To avoid ischemic complication and delayed administration of adjuvant chemotherapy, we have introduced the left gastric artery (LGA) reconstructing/preserving DP-CAR. Methods: This study reviewed 42 consecutive patients with pancreatic body cancer who underwent LGA reconstructing/preserving DP-CAR at our institution. If the distance between the tumor and the LGA was less than 1 cm, the LGA was cut and reconstructed. Results: Among 42 patients (24 men and 18 women with a median age of 68 years), the LGA was reconstructed in 20 patients and preserved in 22 patients, median blood loss was 590 ml and median surgical time was 446 min. 16 patients (38%) had neoadjuvant chemotherapy, R0 resection rate was 85%, and the perioperative blood transfusion rate was 0%. Ischemic gastropathy occurred in two patients (4.8%), no ischemic liver dysfunction or mortality occurred. Postoperative adjuvant chemotherapy was given 87% patients with median starting time of 67 postoperative days and the treatment continuation rate for half a year was 88%. For all 42 patients, the 1-, 3-, and 5-year overall survival rates were respectively 89.4, 44.5, and 22.9 %, and the median survival time was 28.3 months. Conclusion: LGA reconstructing/preserving DP-CAR is good approach for locally advanced pancreatic body cancer with high surgical radicality and preservation of organ function leading to smooth introduction of adjuvant therapy.