Staged celiac artery resection with pancreatosplenectomy (SCARPS) - a novel approach to pancreatic cancer encasing celiac axis trunk robotically
File(s)JSUR-1839.pdf (2.29 MB)
Published version
Author(s)
Type
Journal Article
Abstract
To avoid hepatobiliary and gastric ischaemia related directly to Appleby and Kondo’s procedures, a novel SCARPS procedure (Staged Celiac Artery Resection with PancreatoSplenectomy) for resection of pancreatic cancer involving celiac axis trunk is described here. A 67-year-old female with biopsy proven Pancreatic Ductal Adenocarcinoma (PDAC) encasing celiac and common hepatic artery underwent two stage robotic operation with Da Vinci Xi following 12 cycles of neoadjuvant FOLFIRINOX and 45 Gy chemoradiation. Stage 1 consisted of diagnostic laparoscopy and ligation of Common Hepatic Artery (CHA) after a trial of vascular clamping with real time assessment of hepatic artery flow using laparoscopic / robotic intraoperative doppler ultrasound and stage 2 resection of celiac axis trunk and CHA with pancreatosplenectomy 2 weeks after stage 1 following a repeat CT abdomen/pancreas. Both procedures were performed robotically. Hepatic Artery Resistive Index (HARI) increased to 0.8 after ligation of CHA with preserved forward flows. The operative time was 80 min and 240 min for stage 1 and 2 respectively with minimal blood loss without perioperative blood transfusion. SCARPS offers a safe ligation of CHA following an intraoperative assessment of disease status and a real-time hepatic haemodynamic study prior to major pancreatosplenectomy with celiac axis trunk resection. Furthermore, it is described fervently as a minimally invasive approach to resection of pancreatic cancer with vascular involvement to benefit patients directly for quick recovery.
Date Issued
2023-07-05
Date Acceptance
2023-07-03
Citation
Journal of Surgery, 2023, 8 (12), pp.1-6
Publisher
Gavin Publishers
Start Page
1
End Page
6
Journal / Book Title
Journal of Surgery
Volume
8
Issue
12
Copyright Statement
© 2023 by the Authors & Gavin Publishers. This is an Open Access Journal Article Published Under Attribution-Share Alike CC BY-SA: Creative Commons Attribution-Share Alike 4.0 International License. With this license, readers can share, distribute, download, even commercially, as long as the original source is properly cited. Read More.
Identifier
http://dx.doi.org/10.29011/2575-9760.001839
Publication Status
Published
Date Publish Online
2023-07-05