Background: With the advent of effective chemotherapy, conversion surgery (CS) has been performed in patients who have responded to pretreatment, even for pancreatic cancer diagnosed as unresectable (UR) at the time of initial diagnosis. In CS, major arterial resection and reconstruction are necessary for complete radical resection. Methods: We discuss the key points for safely performing pancreatectomy with celiac axis (CA) resection combined with reconstruction, divided into resection and arterial reconstruction. The possibility of safe pancreatectomy concurrent with CA resection and reconstruction depends on the ability to create a “golden view” that provides an unimpaired view of the Abdominal Aorta, CA, Superior Mesenteric Artery, Inferior Vena Cava, and left renal vein from the ventral side. Pancreatectomy concurrent with CA resection requires arterial reconstruction. Postoperatively, arterial blood flow must be maintained. To achieve this, tension-free and short bypass should be observed. Results: From 2014 to 2024, sixteen URLA patients underwent CS, requiring major artery en bloc resection after pretreatment. We performed DP-CAR in eight patients, gastrectomy-distal pancreatectomy-splenectomy (Appleby procedure) procedure in one patient, PD-CHAR in two patients, PD-CAR in two patients, TP-CAR(spleen preserving) in one patient, and TP-CAR+TG in two patients. In total, five patients required surgery with CA reconstruction. Histopathologically, four of the five patients had T4 pancreatic cancer. The R0 surgical rate was 80%. Complication of Clavien–Dindo IIIa or higher was observed in one patient. There were no deaths. Conclusions: Parallel to the determination of pretreatment, surgeons must be prepared to safely and reliably perform pancreatectomies that require concurrent major arterial resection and reconstruction.
背景：随着有效化疗方案的出现，转化手术（CS）已应用于对前期治疗有反应的患者，即使是初始诊断时被判定为不可切除（UR）的胰腺癌。在转化手术中，为达到完全根治性切除，常需进行主要动脉的切除与重建。 方法：本文探讨了安全实施联合腹腔干（CA）切除与重建的胰腺切除术的关键要点，分为切除与动脉重建两部分。安全实施联合CA切除与重建的胰腺切除术，取决于能否建立“黄金视野”——即从腹侧清晰、无遮挡地观察腹主动脉、腹腔干、肠系膜上动脉、下腔静脉及左肾静脉。联合CA切除的胰腺切除术需进行动脉重建，术后必须维持动脉血流。为此，应遵循无张力及短路径搭桥原则。 结果：2014年至2024年间，16例局部晚期不可切除胰腺癌患者接受前期治疗后行转化手术，需整块切除主要动脉。其中8例实施远端胰腺切除联合腹腔干切除（DP-CAR），1例实施胃切除-远端胰腺切除-脾切除（Appleby术式），2例实施胰十二指肠切除联合肝总动脉-腹腔干切除（PD-CHAR），2例实施胰十二指肠切除联合腹腔干切除（PD-CAR），1例实施全胰切除联合腹腔干切除（保脾），2例实施全胰切除联合腹腔干切除及全胃切除（TP-CAR+TG）。共5例患者需行腹腔干重建手术。组织病理学显示，其中4例为T4期胰腺癌。R0切除率达80%，1例出现Clavien-Dindo IIIa级及以上并发症，无死亡病例。 结论：在确定前期治疗方案的同时，外科医生必须做好安全、可靠地实施需联合主要动脉切除与重建的胰腺切除术的准备。
Pancreatectomy with Celiac Axis Resection and Reconstruction for Locally Advanced Pancreatic Cancer
肿瘤(癌症)患者之家