Two-Stage Mayo Clinic Class IIIb Celiac Axis Resection for Pancreatic Adenocarcinoma: Stepwise Management

被引：1

作者：

Garnier, Jonathan ^{[1
,2
]}

Garg, Karan ^{[3
]}

Levine, Jamie ^{[4
]}

Ratner, Molly ^{[3
]}

Diskin, Brian E. ^{[1
]}

Marchetti, Alessio ^{[1
,5
]}

Javed, Ammar A. ^{[1
]}

Morgan, Katherine A. ^{[1
]}

Salinas, Camila Hidalgo ^{[1
]}

Hewitt, D. Brock ^{[1
]}

Sacks, Greg D. ^{[1
]}

Wolfgang, Christopher L. ^{[1
]}

机构：

[1] NYU Grossman Sch Med, Div Hepatobiliary & Pancreat Surg, NYU Langone Hlth, New York, NY 11501 USA

[2] Inst Paoli Calmettes, Dept Surg Oncol, Marseille, France

[3] NYU Langone Hlth, NYU Grossman Sch Med, Div Vasc Surg, New York, NY USA

[4] NYU, Grossman Sch Med, NYU Langone Hlth, Div Plast Surg, New York, NY USA

[5] Univ Verona, Pancreas Inst, Gen & Pancreat Surg Unit, Verona, Italy

来源：

ANNALS OF SURGICAL ONCOLOGY | 2025年 / 32卷 / 04期

关键词：

D O I：

10.1245/s10434-024-16673-z

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BackgroundThe National Comprehensive Cancer Network guidelines consider pancreatic cancer with celiac axis (CA), proper hepatic artery (PHA), and superior mesenteric artery (SMA) involvement unresectable. Thus, technical reports and video illustrations of these operations are rare. We report the stepwise management of multivascular reconstruction for Mayo Clinic class IIIb CA resections at New York University Langone Health, a dedicated center of excellence in pancreatic surgery.MethodsWe illustrated the management of a 56-year-old patient with biopsy-confirmed pancreatic ductal adenocarcinoma arising from the pancreatic body and involving the CA, PHA, SMA, and mesentericoportal venous axis.Perioperative managementThe preoperative stepwise considerations include: 1) mandatory patient selection; 2) planning vascular reconstructability; 3) tailoring risk assessment while carefully considering the need for total pancreatectomy, total gastrectomy, and mesenteric/hepatic revascularization; and 4) 3D-reconstruction for arterial evaluation. The key intraoperative considerations include: 1) selective and sequential clamping for vascular reconstruction in a "domino" fashion, to minimize warm ischemic time 2) a combined multi-surgeon approach to comprehensively tackle vascular reconstructions; 3) a low threshold for total pancreatectomy to avoid pancreatic leak; and 4) two-stage surgery to reassess the blood supply to the liver and stomach for on-demand gastric preservation instead of a theoretically advised total gastrectomy.ConclusionLiver, stomach, and bowel vascularization present life-threatening risks that require an extensive preoperative evaluation and a multidisciplinary approach. Our stepwise management for these extensive operations includes total pancreatectomy, "domino" vascular reconstruction, and two-stage surgery.

引用

页码：2476 / 2478

页数：3