Combined preoperative segmental hepatic arteries embolization with hepatic artery resection in radical pancreatic resections for locally advanced pancreatic cancer.

Abstract

e16386 Background: Locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) combined with hepatic arteries invasion is usually considered unresectable. This study explores a new procedure with preoperative segmental hepatic arteries embolization and hepatic artery resection and evaluate its safety. Methods: All LA-PDAC patients received neoadjuvant chemotherapy and had stable or partially remission tumors as assessed by CT imaging. Before surgery, all patients underwent preoperative segmental hepatic arteries embolization, include right hepatic artery (RHA), left hepatic artery (LHA) and left gastric artery (LGA). Results: Pancreaticoduodenectomy was performed in 8 patients and distal pancreatectomy in 2 patients, combined with hepatic artery resection. No perioperative deaths occurred, and all patients achieved R0 resection. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were normal after hepatic arterial embolization. The average peak values of ALT and AST after surgery were 734.7 and 805.5 respectively, and the average time for ALT and AST levels to return to normal was 8.5 days. Two patients had localized hepatic ischemia after surgery, but no patient had liver abscess. Conclusions: The novel surgical approach of radical pancreatic cancer resection combined with preoperative hepatic artery embolization and hepatic artery resection is feasible and safe for LA-PDAC patients with hepatic artery invasion. This study provides evidence supporting the potential use of this procedure in such cases.