Left Gastric Artery Reconstruction Using Middle Colic Artery in Distal Pancreatectomy With Celiac Axis Resection:...

Pancreatic cancer with arterial involvement has been traditionally considered unresectable. However, recent advances in multimodal therapy and surgical techniques have made radical resection possible in selected cases. This study aimed to evaluate arterial patency rates and clinical outcomes from short- to long-term follow-up in patients who underwent distal pancreatectomy with celiac axis resection (DP-CAR) and reconstruction.

A retrospective study was conducted on patients who underwent DP-CAR from 2006 to 2022. The primary outcomes were ischemic complications and arterial patency rates. Secondary outcomes included perioperative complications and survival.

Of 620 pancreatic resections, 30 patients underwent DP-CAR. Fifteen patients underwent arterial reconstruction, primarily using the middle colic artery (MCA). Severe complications occurred in 8 patients (26.7%), with zero 90-day mortality. Ischemic gastropathy occurred in 3/8 patients (37.5%) without LGA reconstruction but in none of the reconstruction group (p = 0.032). Among 15 LGA reconstructions, 6 cases (40%) maintained patency throughout follow-up, with a median patency duration of 2.3 months for all reconstruction cases and 25.1 months for cases with maintained patency. All arterial occlusions occurred within 4 months postoperatively without adverse events. Gallbladder ischemia was observed in 2/7 patients (28.6%) with LGA reconstruction but in none without reconstruction. No hepatic ischemia was observed in either group. The median overall survival from initial treatment was 50.4 months, with a 5-year survival rate of 43.7%. The R0 resection rate was 90.0%.

DP-CAR with arterial reconstruction can be safely performed in selected patients, achieving favorable long-term outcomes. LGA reconstruction appears crucial in preventing ischemic gastropathy.