Two Cases of Cancer of the Pancreatic Body Undergoing Gastric Preservation with Distal Pancreatectomy Combined with Resection of the Celiac Axis

Shoichi Hishinuma, Yoshiro Ogata, Junichi Matsui, Iwao Ozawa, Takao Inada, Hideaki Shimizu, Kenjiro Kotake, Tadashi Ikeda, Yasuo Koyama

Department of Surgery, Tochigi Cancer Center

In an attempt to improve the postoperative nutritional status and quality of life of pancreatic cancer patients, two patients with cancer of the pancreatic body accompanied by tumor invasion around the celiac axis underwent a new operative procedure. The celiac axis was divided at the origin from the aorta. The common hepatic artery was divided just proximal to the gastroduodenal artery and the left gastric artery was divided at its periphery. Then the pancreatic body and tail and the spleen were removed with the celiac axis. In one of the patients, the portal vein was also resected because of cancer invasion. Great care was taken to preserve the inferior pancreaticoduodenal artery which arose from the superior mesenteric artery. Blood supply to the stomach and liver was provided via this artery. These two patients received both intra-and post-operative irradiation to the tumor bed. No postoperative complications were encountered. Pathological examination of the resected specimens revealed that in both patients the resections were non-curative resection because of exposure of cancer at the surgical margins. The first patient developed peritonitis carcinomatosa and had two exploratory operations for relief of the bowel obstruction. However, he has survived 41 months without local or hepatic failure. Unfortunately, the second patient died from an accident 4 months after the operation. Recurrence was obscure. Up to now, this operative procedure for cancer of the pancreatic body has not been reported.

Key words
distal pancreatectomy, combined resection of the celiac axis, preservation of the stomach

Reprint requests
Shoichi Hishinuma Department of Surgery, Tochigi Cancer Center
4-9-13 Yohnan, Utsunomiya-shi, 320, JAPAN

Accepted
June 5, 1991

To read the PDF file you will need Abobe Reader installed on your computer.