Is hepatic artery coil embolization useful in distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer?
Is hepatic artery coil embolization useful in distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer?
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DOI：
10.1186/s12957-019-1667-8
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发表时间：
2019-07-17
影响因子：
3.2
通讯作者：
Ohtsuka, Masayuki
中科院分区：
文献类型：
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作者：
Ueda, Atsuhiko;Sakai, Nozomu;Ohtsuka, Masayuki
背景资料：术前弹簧圈栓塞在胰腺远端切除术中的确切贡献与整块腹腔干切除术（DP-CAR）预防缺血性肝脏并发症尚未完全阐明。方法：从2004年1月至2015年7月，31例患者接受DP-CAR治疗胰腺体尾癌。23例患者接受了术前弹簧圈栓塞。结果：全组中位生存时间为23.7个月，1年和3年总生存率分别为74.2%和34.4%。所有患者均未发生30天死亡。尽管8例患者中有7例接受了术前弹簧圈栓塞，但仅8例患者（25.8%）发生了术后肝梗死。术前多探测器计算机断层扫描（MDCT）上肿瘤与胃十二指肠动脉（GDA）/肝固有动脉（PHA）的接触、肿瘤大小、手术时间、门静脉切除和DP-CAR后GDA/PHA狭窄与肝梗死相关。其中，MDCT显示的GDA/PHA术后狭窄是与术后肝梗死最密切相关的因素，在所有8例肝梗死患者中均观察到。肿瘤接触GDA/PHA没有恶化R 0切除率或总生存率。结论：我们的数据表明，术前弹簧圈栓塞肝总动脉是没有用的DP-CAR，只要GDA是完全保存在手术过程中。
Background: The exact contribution of preoperative coil embolization in distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for the prevention of ischemic liver complication is not fully elucidated.Methods: From January 2004 to July 2015, 31 patients underwent DP-CAR for the pancreatic body-tail cancer. Twenty-three patients received preoperative coil embolization. The characteristics and operative outcomes were analyzed retrospectively.Results: The median survival time and 1- and 3-year overall survival rates were 23.7 months and 74.2% and 34.4%, respectively. No 30-day mortality occurred in any of the patients. Postoperative liver infarction developed only in 8 patients (25.8%) even though 7 of 8 patients had undergone preoperative coil embolization. Tumor contact with the gastroduodenal artery (GDA)/proper hepatic artery (PHA) on preoperative multi-detector computed tomography (MDCT), tumor size, operative time, portal vein resection, and stenosis of the GDA/PHA after DP-CAR are related to liver infarction. Among them, postoperative stenosis of the GDA/PHA on MDCT, which was observed in all 8 patients with liver infarction, was the most closely related factor to postoperative liver infarction. Tumor contact with the GDA/PHA did not worsen the R0 resection rate or overall survival rate.Conclusion: Our data indicate that preoperative coil embolization of the common hepatic artery is not useful in DP-CAR as long as GDA is completely preserved during surgery.