Distal pancreatectomy with en bloc celiac axis resection after neoadjuvant therapy for locally advanced pancreatic adenocarcinoma.

摘要

Pancreatic adenocarcinoma has a notoriously poor prognosis. Multiple studies have shown that the best outcomes result from curative resections. Unfortunately, most patients present with lesions that are already unresectable because of either local vascular invasion or metastasis. Traditionally, vascular invasion by a pancreatic tumor negated the possibility of surgery, but developments in vascular resection technique have expanded the pool of patients who are candidates for surgery. In 1953, Appleby described distal pancreatectomy and total gastrectomy with en bloc resection of the celiac axis as a treatment of locally advanced gastric cancer. After celiac axis resection, adequate blood flow to the foregut is maintained by collateral circulation between the superior mesenteric artery (SMA) and the hepato-biliary system via an intact pancreati-coduodenal arcade. En bloc celiac axis resection, with a number of modifications, has since been used to treat locally advanced cancer of the pancreatic body.