Abstract
Background
Liver ischemia may occur during intraoperative common hepatic artery ligation in Mayo
Clinic class I distal pancreatectomy with en bloc celiac axis resection (DP-CAR).
Preoperative liver arterial conditioning could be used to avoid this outcome. This
retrospective study compared arterial embolization (AE) or laparoscopic ligation (LL)
of the common hepatic artery before class Ia DP-CAR.
Methods
From 2014 to 2022, 18 patients were scheduled for class Ia DP-CAR after neoadjuvant
FOLFIRINOX treatment. Two were excluded due to hepatic artery variation, six underwent
AE, ten underwent LL.
Results
Two procedural complications occurred in the AE group: an incomplete dissection of
the proper hepatic artery and a distal migration of coils in the right branch of the
hepatic artery. Neither complication prevented surgery. The median delay between conditioning
and DP-CAR was 19 days; decreased to five days in the last six patients. None required
arterial reconstruction. Morbidity and 90-day mortality rates were 26.7% and 12.5%,
respectively. No patient developed postoperative liver insufficiency after LL.
Conclusion
Preoperative AE and LL seem comparable in averting arterial reconstruction and postoperative
liver insufficiency in patients scheduled for class Ia DP-CAR. However, serious complications
that may arise during AE led us to prefer the LL technique.
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Article info
Publication history
Published online: January 19, 2023
Accepted:
January 16,
2023
Received:
April 2,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc.
