Distal Pancreatectomy with Celiac Axis and Venous Resection with Hepatic Artery and Venous Reconstruction (DP-CARV) for Locally Advanced Pancreatic Adenocarcinoma.

Fiche publication

Date publication

décembre 2024

Journal

Annals of surgical oncology

Auteurs

Membres identifiés du Cancéropôle Est :
Pr BACHELLIER Philippe

Tous les auteurs :
Addeo P, de Mathelin P, Paul C, Bachellier P

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/39666188

Résumé

Surgery has recently been introduced into the multimodal management of patients with locally advanced pancreatic adenocarcinomas (LAPCs) thanks to the major pathological response seen with the advent of the multiagent regimen FOLFIRINOX. Distal pancreatectomy with celiac axis resection (DP-CAR) may be complicated by ischemic liver and gastric events. Common hepatic artery reconstruction may prevent the occurrence of ischemic complications and can be an alternative to preoperative embolization of the celiac trunk. METHODS: The patient was a 65-year-old with LAPC of the pancreatic body, with infiltration of the celiac trunk, the splenoportal venous confluence, and the Treitz angle. Preoperative induction chemotherapy with FOLFIRNOX was administered over 12 cycles, resulting in radiological stability and normal carbohydrate antigen (CA) 19-9 levels. Positron emission tomography showed isolated activity of the tumor without distant metastasis. A DP-CARV procedure was performed, and a single saphenous graft was used to reconstruct the common hepatic artery and to create a venous patch to repair the venous confluence. The angle of the Treitz, along with the third and fourth duodenum, were resected and a duodenojejunal anastomosis on the second duodenal portion was performed. The left gastric artery was not reconstructed.