Pancreaticoduodenetomy combined with hepatic artery resection following preoperative hepatic arterial embolization

BackgroundThe possibility of resection for locally advanced pancreatic ductal adenocarcinoma (PDAC) with involvement of hepatic or superior mesenteric artery is low. The treatment strategy for these locally advanced PDAC needs to be elucidated. MethodsWe retrospectively reviewed the medical records of 107 patients undergoing pancreaticoduodenectomy for PDAC between 2007 and 2012. Among these patients, seven patients who had unresectable PDAC because of cancer involvement of hepatic artery underwent preoperative hepatic arterial embolization and subsequent pancreaticoduodenectomy combined with resection of hepatic artery without reconstruction (PDCAR). We specifically focused on these seven patients to clarify the benefit and drawback of PDCAR. ResultsSerum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels on 1 day after hepatic arterial embolization increased, but returned to baseline before pancreaticoduodenectomy. There was no arterial embolization-related complication before surgery. Serum ALT and AST levels increased 1 day after surgery, but thereafter returned to baseline. Although postoperative morbidity such as hepatic infarction was observed in one case, there were no in-hospital deaths. The median survival time was 12.6 months and 5-year survival rate was 19%. ConclusionPreoperative hepatic arterial embolization and subsequent PDCAR might be a feasible procedure in selected patients with unresectable locally advanced PDAC with hepatic artery involvement.