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Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature
BACKGROUND: During pancreaticoduodenectomy in patients with celiac axis (CA) stenosis due to compression by the median arcuate ligament (MAL), the MAL has to be divided to maintain hepatic blood flow in many cases. However, MAL division often fails, and success can only be determined intraoperativel...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8900579/ https://www.ncbi.nlm.nih.gov/pubmed/35317096 http://dx.doi.org/10.3748/wjg.v28.i8.868 |
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author | Yoshida, Eiji Kimura, Yasutoshi Kyuno, Takuro Kawagishi, Ryoko Sato, Kei Kono, Tsuyoshi Chiba, Takehiro Kimura, Toshimoto Yonezawa, Hitoshi Funato, Osamu Kobayashi, Makoto Murakami, Kenji Takagane, Akinori Takemasa, Ichiro |
author_facet | Yoshida, Eiji Kimura, Yasutoshi Kyuno, Takuro Kawagishi, Ryoko Sato, Kei Kono, Tsuyoshi Chiba, Takehiro Kimura, Toshimoto Yonezawa, Hitoshi Funato, Osamu Kobayashi, Makoto Murakami, Kenji Takagane, Akinori Takemasa, Ichiro |
author_sort | Yoshida, Eiji |
collection | PubMed |
description | BACKGROUND: During pancreaticoduodenectomy in patients with celiac axis (CA) stenosis due to compression by the median arcuate ligament (MAL), the MAL has to be divided to maintain hepatic blood flow in many cases. However, MAL division often fails, and success can only be determined intraoperatively. To overcome this problem, we performed endovascular CA stenting preoperatively, and thereafter safely performed pancreaticoduodenectomy. We present this case as a new preoperative treatment strategy that was successful. CASE SUMMARY: A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for surgery. Preoperative assessment revealed CA stenosis caused by MAL. We performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic complications. Double-antiplatelet therapy (DAPT) – which is needed when a stent is inserted – was then administered in parallel with neoadjuvant chemotherapy (NAC). This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from NAC. Subtotal stomach-preserving pancreaticoduodenectomy was then performed. The operation did not require any unusual techniques and was performed safely. Postoperatively, the patient progressed well, without any ischemic complications. Histopathologically, curative resection was confirmed, and the patient had no recurrence or complications due to ischemia up to six months postoperatively. CONCLUSION: Preoperative endovascular stenting, with NAC and DAPT, is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer. |
format | Online Article Text |
id | pubmed-8900579 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-89005792022-03-21 Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature Yoshida, Eiji Kimura, Yasutoshi Kyuno, Takuro Kawagishi, Ryoko Sato, Kei Kono, Tsuyoshi Chiba, Takehiro Kimura, Toshimoto Yonezawa, Hitoshi Funato, Osamu Kobayashi, Makoto Murakami, Kenji Takagane, Akinori Takemasa, Ichiro World J Gastroenterol Case Report BACKGROUND: During pancreaticoduodenectomy in patients with celiac axis (CA) stenosis due to compression by the median arcuate ligament (MAL), the MAL has to be divided to maintain hepatic blood flow in many cases. However, MAL division often fails, and success can only be determined intraoperatively. To overcome this problem, we performed endovascular CA stenting preoperatively, and thereafter safely performed pancreaticoduodenectomy. We present this case as a new preoperative treatment strategy that was successful. CASE SUMMARY: A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for surgery. Preoperative assessment revealed CA stenosis caused by MAL. We performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic complications. Double-antiplatelet therapy (DAPT) – which is needed when a stent is inserted – was then administered in parallel with neoadjuvant chemotherapy (NAC). This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from NAC. Subtotal stomach-preserving pancreaticoduodenectomy was then performed. The operation did not require any unusual techniques and was performed safely. Postoperatively, the patient progressed well, without any ischemic complications. Histopathologically, curative resection was confirmed, and the patient had no recurrence or complications due to ischemia up to six months postoperatively. CONCLUSION: Preoperative endovascular stenting, with NAC and DAPT, is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer. Baishideng Publishing Group Inc 2022-02-28 2022-02-28 /pmc/articles/PMC8900579/ /pubmed/35317096 http://dx.doi.org/10.3748/wjg.v28.i8.868 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/ |
spellingShingle | Case Report Yoshida, Eiji Kimura, Yasutoshi Kyuno, Takuro Kawagishi, Ryoko Sato, Kei Kono, Tsuyoshi Chiba, Takehiro Kimura, Toshimoto Yonezawa, Hitoshi Funato, Osamu Kobayashi, Makoto Murakami, Kenji Takagane, Akinori Takemasa, Ichiro Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature |
title | Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature |
title_full | Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature |
title_fullStr | Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature |
title_full_unstemmed | Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature |
title_short | Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature |
title_sort | treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: a case report and review of literature |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8900579/ https://www.ncbi.nlm.nih.gov/pubmed/35317096 http://dx.doi.org/10.3748/wjg.v28.i8.868 |
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