Successful Conversion Surgery of Common Hepatic Arterial and Portal Vein Resection Combined with Preoperative Chemotherapy and Coil Embolization for Locally Advanced Pancreatic Cancer: A Case Report

Abstract

The standard treatment for unresectable locally advanced pancreatic ductal adenocarcinoma (UR-LA PDAC) is chemotherapy or chemoradiotherapy except for surgery. Although conversion surgery (CS) for UR-LA PDAC has been useful strategy, owing to recent advances in the other treatment, the significance and safety of CS remains unclear. We described a case of successful conversion surgery of common hepatic arterial and portal vein resection combined with chemotherapy and preoperative coil embolization for locally advanced pancreatic cancer. A 65-year-old man was diagnosed with UR-LA PDAC which was in contact with common hepatic artery (CHA) -gastroduodenal artery (GDA)-proper hepatic artery (PHA), with invasion extending from the superior mesenteric vein (SMV) to portal vein (PV) without distant metastasis. After gemcitabine plus nab-paclitaxel, the primary tumor had decreased and tumor contacts with the CHA and invasion extending from the SMV to PV were still observed, indicating to the change of borderline resectable PDAC (BR-A). We performed preoperative CHA and GDA embolization to prevent postoperative ischemic complications. Five days after embolization, pancreaticoduodenectomy (PD) with common hepatic arterial resection and portal vein resection were performed, preserving right gastric artery (RGA). Arterial reconstruction was not performed as intraoperative ultrasonography confirmed RGA-PHA blood flow was sufficient to cover the bilateral lobes of the liver. Although liver enzymes levels were moderately increased, the patient was discharged on postoperative day 15 without any ischemic liver event. He had received adjuvant chemotherapy with S-1 for 12 months and alive at 36 months after initial treatment without any tumor recurrence.