Why we don’t need hepatic artery reconstruction during DP-CAR? experience of 20 modified appleby procedures

Abstract

Background: Distal pancreatectomy with celiac artery resection (DPCAR) is in use for borderline-resectable pancreatic cancer. It is believed that considerable reduction of the liver arterial supply after DPCAR may cause severe liver ischemia. Although the artery reconstruction is not a problem anymore the decision to reconstruct artery has to be justified To study liver collateral arterial supply after temporary CHA, right gastroepiploic and accessory/replaced left hepatic arteries (a/rLHA). Methods: Arterial anatomy, diameters of CHA, proper hepatic (PHA), gastroduodenal(GDA) and pancreatoduodenal arteries(PDA) were registered before surgery in 110 consecutive patients with pancreatic body/tail cancer(n35), gastric cancer with pancreatic involvementn30) and liver tumors(n45)by CT. For DPCAR(n20) these data were obtained after surgery as well. Diameters of peripancreatic arteries and mean systolic blood velocity in hepatic arteries before and after CHA clamping were measured intraoperatively by Doppler ultrasound. Results: Pulse disappeared in 19 (17 %) cases after clamping of CHA,RGEA and aLHA/rLPA. Collateral arterial blood flow in the liver parenchyma was revealed in all cases. DPCAR led to increase of GDA, rRHA, PDA and RGEA blood flow in 0,9-12 times Conclusion: Doppler ultrasound is a reliable modality for intraoperative assessment of liver arterial blood supply after DPCAR; Hepatic artery reconstruction may be necessary after DPCAR in case of disappearance of arterial US signal upon the liver parenchyma.