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Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report
INTRODUCTION AND IMPORTANCE: Recent advances in chemotherapy and chemoradiotherapy allow performance of conversion surgery by improving tumor shrinkage in select patients with initially unresectable locally advanced pancreatic cancer (LAPC), thereby providing curative potential. The number of conver...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771041/ https://www.ncbi.nlm.nih.gov/pubmed/33360334 http://dx.doi.org/10.1016/j.ijscr.2020.12.041 |
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author | Tanaka, Hideharu Imai, Hisashi Higashi, Toshiya Murase, Katsutoshi Matsuhashi, Nobuhisa Yoshida, Kazuhiro |
author_facet | Tanaka, Hideharu Imai, Hisashi Higashi, Toshiya Murase, Katsutoshi Matsuhashi, Nobuhisa Yoshida, Kazuhiro |
author_sort | Tanaka, Hideharu |
collection | PubMed |
description | INTRODUCTION AND IMPORTANCE: Recent advances in chemotherapy and chemoradiotherapy allow performance of conversion surgery by improving tumor shrinkage in select patients with initially unresectable locally advanced pancreatic cancer (LAPC), thereby providing curative potential. The number of conversion surgeries requiring arterial reconstruction for select patients with initially unresectable LAPC following favorable responses is expected to increase, so providing effective options for safe arterial reconstruction is critical. CASE PRESENTATION: Herein we report a case of successful conversion surgery for initially unresectable LAPC with splenic artery transposition for hepatic arterial reconstruction after gemcitabine/nab-paclitaxel (GnP). A 71-year-old woman was referred to our hospital for evaluation of a pancreatic head mass after developing diabetes. She was diagnosed with unresectable LAPC, which was in wide contact with the common hepatic artery (CHA), proper hepatic artery (PHA), and splenic artery (SA). She received GnP, and after 6 cycles, durations of disease control and normalization of serum carbohydrate antigen 19-9 (CA19-9) exceeded 7 months. She underwent radical subtotal stomach-preserving pancreaticoduodenectomy with CHA-PHA and portal vein (PV) resection (SA-right hepatic artery anastomosis/PV-superior mesenteric vein direct end-to-end anastomosis). Histopathological examination revealed R0 resection with a histological response of Evans grade IIB. No signs of tumor recurrence have been observed for 14 months postoperatively. CLINICAL DISCUSSION: No consensus has been reached regarding the optimal treatment regimen, duration, or criteria for conversion surgery in patients with LAPC, especially in cases requiring arterial resection. SA transposition for hepatic arterial reconstruction is generally very consistent, easily accessible, and offers adequate length and diameter for successful arterial anastomosis. CONCLUSION: Even for a SA initially in contact with the tumor, SA transposition for hepatic artery reconstruction is a safe and effective option when tumor contact disappears due to chemotherapy. |
format | Online Article Text |
id | pubmed-7771041 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-77710412020-12-30 Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report Tanaka, Hideharu Imai, Hisashi Higashi, Toshiya Murase, Katsutoshi Matsuhashi, Nobuhisa Yoshida, Kazuhiro Int J Surg Case Rep Case Report INTRODUCTION AND IMPORTANCE: Recent advances in chemotherapy and chemoradiotherapy allow performance of conversion surgery by improving tumor shrinkage in select patients with initially unresectable locally advanced pancreatic cancer (LAPC), thereby providing curative potential. The number of conversion surgeries requiring arterial reconstruction for select patients with initially unresectable LAPC following favorable responses is expected to increase, so providing effective options for safe arterial reconstruction is critical. CASE PRESENTATION: Herein we report a case of successful conversion surgery for initially unresectable LAPC with splenic artery transposition for hepatic arterial reconstruction after gemcitabine/nab-paclitaxel (GnP). A 71-year-old woman was referred to our hospital for evaluation of a pancreatic head mass after developing diabetes. She was diagnosed with unresectable LAPC, which was in wide contact with the common hepatic artery (CHA), proper hepatic artery (PHA), and splenic artery (SA). She received GnP, and after 6 cycles, durations of disease control and normalization of serum carbohydrate antigen 19-9 (CA19-9) exceeded 7 months. She underwent radical subtotal stomach-preserving pancreaticoduodenectomy with CHA-PHA and portal vein (PV) resection (SA-right hepatic artery anastomosis/PV-superior mesenteric vein direct end-to-end anastomosis). Histopathological examination revealed R0 resection with a histological response of Evans grade IIB. No signs of tumor recurrence have been observed for 14 months postoperatively. CLINICAL DISCUSSION: No consensus has been reached regarding the optimal treatment regimen, duration, or criteria for conversion surgery in patients with LAPC, especially in cases requiring arterial resection. SA transposition for hepatic arterial reconstruction is generally very consistent, easily accessible, and offers adequate length and diameter for successful arterial anastomosis. CONCLUSION: Even for a SA initially in contact with the tumor, SA transposition for hepatic artery reconstruction is a safe and effective option when tumor contact disappears due to chemotherapy. Elsevier 2020-12-23 /pmc/articles/PMC7771041/ /pubmed/33360334 http://dx.doi.org/10.1016/j.ijscr.2020.12.041 Text en © 2020 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Tanaka, Hideharu Imai, Hisashi Higashi, Toshiya Murase, Katsutoshi Matsuhashi, Nobuhisa Yoshida, Kazuhiro Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report |
title | Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report |
title_full | Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report |
title_fullStr | Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report |
title_full_unstemmed | Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report |
title_short | Splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: A case report |
title_sort | splenic artery transposition for hepatic arterial reconstruction in conversion surgery of an initially unresectable, locally advanced pancreatic cancer after gemcitabine/nab-paclitaxel: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771041/ https://www.ncbi.nlm.nih.gov/pubmed/33360334 http://dx.doi.org/10.1016/j.ijscr.2020.12.041 |
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