Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery

Surgical Case Reports

Tetsuya Shinobi¹  Katsuhiro Miura²  Hideki Ishizu³  Naoko Irie⁴  Tatsuo Ichikawa⁴  Itaru Shigeyoshi⁴  Kozo Asanuma⁴  Tadao Kuribara⁴  Akira Iai⁴  Shiori Kaneko⁴  Satoshi Ono⁴  Kouta Matsubara⁴  Takeshi Inoue⁴  Kiyoshi Osa⁴  Takayuki Sano⁴ 

[1] Department of Internal Medicine, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, Japan;Department of Internal Medicine, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, Japan;Tumor Center, Nihon University Itabashi Hospital, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, Japan;Department of Hematology and Rheumatology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, Japan;Department of Pathology, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, Japan;Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, 333-0831, Saitama, Japan;

关键词: Pancreatic cancer;    Pancreaticoduodenectomy;    Conversion surgery;    Hepatic arterial resection;    Aberrant hepatic artery;    Embolization;    Chemotherapy;   

DOI  :  10.1186/s40792-020-00997-5

来源: Springer

【 摘 要 】

BackgroundPancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment.Case presentationA 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery.ConclusionsIn PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.

【 授权许可】

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