Common Hepatic Artery Resection and Reconstruction During Pancreaticoduodenectomy Following Chemotherapy for Locally-Advanced Pancreatic Cancer: A Case Report

TL;DR

A patient with advanced pancreatic cancer underwent successful surgery involving hepatic artery reconstruction after chemotherapy.

Contribution

This case report demonstrates a novel surgical technique for hepatic artery reconstruction during pancreatic cancer surgery.

Findings

A direct end-to-end anastomosis was successfully performed without interposition grafting.

The patient had an uneventful recovery following the complex surgical procedure.

Hepatic blood flow was adequately maintained using the described reconstruction method.

Abstract

A 73-year-old female patient was diagnosed with unresectable locally advanced pancreatic cancer at 72 years of age and underwent chemotherapy. Due to a successful response to chemotherapy, she was scheduled for a pancreaticoduodenectomy and common hepatic artery resection by the gastrointestinal surgery department. As the common hepatic artery was to be resected, our cardiovascular surgery department was consulted for vascular reconstruction to ensure hepatic blood flow. During the surgery, our team intervened prior to tumor resection. The pancreaticoduodenal artery was infiltrated by the tumor and required resection. Although the common hepatic artery proximal to its branches had to be resected, we determined that a direct end-to-end anastomosis between the remaining common hepatic artery and the proper hepatic artery was feasible. To maintain a wide anastomotic opening, both ends were trimmed obliquely. An end-to-end anastomosis was performed using 6-0 PROLENE® Polypropylene Suture (Ethicon, Johnson & Johnson, Somerville, NJ, USA). Blood flow was confirmed to be adequate using a flow meter. Subsequently, the gastrointestinal surgery department proceeded with tumor resection. The patient had an uneventful postoperative course and was discharged on postoperative day 22. This case highlights that prompt, direct hepatic arterial reconstruction can safely preserve hepatic inflow without the need for interposition grafting.

Figures