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Survival benefit of conversion surgery for patients with initially unresectable pancreatic cancer who responded favorably to nonsurgical treatment. doi: 10.1245/s1043-7.Īsano T, Hirano S, Nakamura T, Okamura K, Tsuchikawa T, Noji T, et al. Downstaging in pancreatic cancer: a matched analysis of patients resected following systemic treatment of initially locally unresectable disease. In PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.Īberrant hepatic artery Chemotherapy Conversion surgery Embolization Hepatic arterial resection Pancreatic cancer Pancreaticoduodenectomy.īickenbach KA, Gonen M, Tang LH, O'Reilly E, Goodman K, Brennan MF, et al. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. Operation was performed 19 days after embolization. Immediately after embolization, collateral arterial blood flow to the liver was observed. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery.
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After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment.Ī 61-year-old man with back pain was diagnosed with pancreatic head and body cancer.
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Pancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks.