Hello Prof Fishman. In the newest ctisus vodcast, Pam Johnson refers a celiac encasement by a pancreatic body mass as a potentially resectable lesion. Is this really right? I've been hearing all my life that a celiac artery encasement is a defenitely irresectability criteria. If resectable how to perform the artery anastomosis? would you care to comment? Regards.Thanks very much
Pancreatic head cancer encasing the celiac artery is nonresectable. In my talk on pancreatic surgery, I made reference to pancreatic body cancer encasing the celiac artery, which in rare cases, is a resectable lesion. As per a recent article in AJR from the departments of Surgery and Radiology at Johns Hopkins:
"Cancers of the body of the pancreas often invade the celiac trunk or proximal common hepatic artery and preclude resection. In rare instances such cancers can be resected though a radical operation called a distal pancreatectomy or a subtotal pancreatectomy with en bloc resection of the celiac axis (Applebyâ€™s Procedure). This operation is almost always undertaken following standard treatment for borderline resectable or locally advanced adenocarcinoma, which includes pre-operative chemoradiotherapy.
This operation removes the distal neck, body and tail of the pancreas along with the common hepatic artery, celiac trunk, left gastric artery and splenic artery. The spleen is also removed. Blood is supplied to the liver by retrograde flow though the gastroduodenal artery to the proper hepatic artery. Prior to undertaking this procedure, CT angiography is used to delineate tumor extent and vascular anatomy."
Wolfgang CL, Corl F, Johnson PT, Edil BH, Horton KM, Schulick RD, Fishman EK. Pancreatic surgery for the radiologist, 2011: an illustrated review of classic
and newer surgical techniques for pancreatic tumor resection. AJR Am J Roentgenol. 2011 Dec;197(6):1343-50.
Pamela T. Johnson, MD
Assistant Professor of Radiology
Johns Hopkins Hospital
Last edited on Thu Mar 1st, 2012 12:01 pm by ctisus