Pancreatectomy with Celiac Axis Resection and Reconstruction for Locally Advanced Pancreatic Cancer

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Vascular Reconstruction

Background:

• Conversion surgery (CS) is increasingly performed for pancreatic cancer initially diagnosed as unresectable (UR) after neoadjuvant chemotherapy.
• CS for UR pancreatic cancer often necessitates major arterial resection and reconstruction for complete tumor removal.

Purpose of the Study:

• To outline key technical aspects for safely performing pancreatectomy with concurrent celiac axis (CA) resection and reconstruction.
• To emphasize the importance of achieving a "golden view" for unimpeded surgical access and the necessity of tension-free arterial bypass.

Main Methods:

• Discussion of critical steps for pancreatectomy involving celiac axis resection and reconstruction.
• Emphasis on achieving a clear surgical field of major abdominal vessels (Abdominal Aorta, CA, SMA, IVC, LRV).
• Techniques for arterial reconstruction to ensure postoperative blood flow, prioritizing short, tension-free bypass grafts.

Main Results:

• Sixteen patients with unresectable, locally advanced (URLA) pancreatic cancer underwent CS with major artery resection between 2014-2024.
• Various pancreatectomy and celiac axis resection/reconstruction procedures were performed, with five patients requiring CA reconstruction.
• An R0 surgical resection rate of 80% was achieved, with one patient experiencing a Clavien-Dindo grade IIIa or higher complication and no operative mortality.

Conclusions:

• Surgeons must be prepared for complex pancreatectomies involving major arterial resection and reconstruction in the conversion setting.
• Safe and reliable execution of these advanced surgical techniques is crucial for improving outcomes in selected pancreatic cancer patients.