Diameter of IPDA Is Associated With Maintenance of Hepatic Arterial Blood Flow in DP-CAR

Background/Aim: During distal pancreatectomy with celiac axis resection (DP-CAR), hepatic arterial blood flow must be maintained. This study aimed to identify the characteristics of and treatment strategies for patients who are ineligible for DP-CAR.

Patients and Methods: Data from 20 patients for whom DP-CAR was attempted at the University of Toyama from January 2018-June 2023 were retrospectively analyzed.

Results: All patients received preoperative chemotherapy or chemoradiation therapy (CRT). Thirteen patients underwent DP-CAR, and seven patients underwent DP or DP-CAR with common hepatic artery (CHA) reconstruction because intrahepatic hepatic artery blood flow was lost after CHA clamping. In five patients who underwent DP, intraoperative pathological diagnosis confirmed that tissue around celiac artery (CA) or CHA was cancer free. Preoperative enhanced computed tomography images revealed that the inferior pancreaticoduodenal artery (IPDA) diameter was significantly smaller in the DP or DP-CAR with CHA reconstruction group than in the DP-CAR group (1.33 mm vs. 1.78 mm, respectively, p=0.0037). There were no significant differences in recurrence-free survival or overall survival between the DP group and the DP-CAR group.

Conclusion: The IPDA diameter can predict the feasibility of DP-CAR. CA- or CHA-sparing surgery may be acceptable for pancreatic cancer with CA invasion in patients who have undergone CRT.