Distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR)

Common hepatic arterial stump pressure should determine the need for arterial reconstruction

Anubhav Mittal, Philip R. De Reuver, Satya Shanbhag, Ralph F. Staerkle, Michael Neale, Catherine Thoo, Thomas J. Hugh, Anthony J. Gill, Jaswinder S. Samra*

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background Tumors arising in the neck and body of the pancreas often invade the common hepatic artery and celiac axis (CA), necessitating distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR). In these patients, the need for revascularization of the common hepatic artery (CHA) can be avoided on the basis of the pressure change in the CHA after clamping of the CA. Methods All patients presenting to North Shore Hospital Campus of University of Sydney with advanced pancreatic malignancy of the neck and body between 2007 and 2014 were included in the study. The pressure in the CHA was measured pre- and postclamping of the CA; a decrease of more than 25% in the mean arterial pressure necessitated vascular reconstruction of the CHA. Results Seven patients underwent a DPS-CAR between 2007 and 2014. Arterial reconstruction was required in 2 patients based on a decrease of >25% mean arterial pressure in the CHA after clamping the CA. There was no in hospital or 90-day mortality, and no patients developed ischemic hepatitis. Conclusion A single-stage DPS-CAR with selective arterial reconstruction based on the CHA pressure change after clamping the CA is a safe approach.

Original languageEnglish
Pages (from-to)811-817
Number of pages7
JournalSurgery (United States)
Volume157
Issue number4
DOIs
Publication statusPublished - 1 Apr 2015

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