Turkish Journal of Surgery

Turkish Journal of Surgery

ISSN: 2564-6850
e-ISSN: 2564-7032

 

Mustafa Özsoy1, Enes Şahin2, Mustafa Yavuz3, Zehra Özsoy4, Nazan Okur5, Süleyman Şahin1, Sezgin Yılmaz6, Yüksel Arıkan6

Abstract

Surgery is the only treatment method in pancreatic cancer. Unfortunately, metastatic diseases or invasion of the main vascular structures are observed in a majority of cases at the time of diagnosis; these structures originate from the body, neck, and tail of the pancreas and are considered inoperable. The first celiac artery resection for the treatment of cancer was described by Appleby in 1953. Here, we describe our hepatic artery reconstruction technique in a case with pancreatic body cancer. A 37-year-old male patient was admitted to our emergency department owing to syncope. The patient was diagnosed with acute renal failure secondary to fluid loss. Thereafter, his general condition was stable and laboratory results improved. Abdominal computed tomography was performed. Pancreatic cancer originating from the pancreatic body was detected. A pancreatic biopsy was performed and neoadjuvant gemcitabine and paclitaxel chemoradiotherapy were initiated. Surgical treatment was recommended for the identification of regression after neoadjuvant chemoradiotherapy. Following intraoperative Doppler ultrasonography, en bloc distal pancreatectomy and splenectomy involving the celiac artery trunk and total gastrectomy were performed. However, the surgical margin reliability in a frozen section revealed that the tumor was still present. Therefore, the surgical procedure was replaced with total pancreaticoduodenectomy. The hepatic artery reconstruction was performed from the left main iliac artery using a 4-mm ringed GORE-TEX® graft. The iliac–hepatic bypass for hepatic artery reconstruction in pancreatic cancer could be an alternative surgical technique.

Keywords: Appleby, celiac artery, iliac–hepatic bypass, pancreas

Cite this paper as: Özsoy M, Şahin E, Yavuz M, Özsoy Z, Okur N, Şahin S, et al. Alternative hepatic arterial reconstruction technique in case of total pancreaticoduodenectomy after celiac artery resection in pancreas cancer (appleby): Iliac–hepatic bypass. Turk J Surg 2018; 10.5152/turkjsurg.2018.3983.


 

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - M.Ö., M.Y.; Design - Z.Ö.; Supervision - Y.A., S.Y.; Resource - S.Ş.; Materials - N.O.; Data Collection and/or Processing - E.Ş., M.Ö.; Analysis and/or Interpretation - Y.A.; Literature Search - Z.Ö.; Writing Manuscript - Z.Ö.; Critical Reviews - S.Y.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.