Pancreatectomy With Artery En-bloc Resection for Pancreatic Neck/Body Cancer: A Single-arm Pilot Study

BACKGROUND/AIM

The potential benefits of pancreatectomy with major arterial resection have been studied in the past, but findings remain controversial. Pancreatic neck/body cancer (PNBC) involving arteries frequently requires combined resection of the pancreas, artery and portal vein.

PATIENTS AND METHODS

Nine prospectively-registered consecutive patients with PNBC were enrolled, all underwent pancreatoduodenectomy with common hepatic artery en-bloc resection (PD-CHAR). We investigated the safety of PD-CHAR by blood flow evaluation with intraoperative indocyanine green fluorescence imaging in reconstructed vessels/organs.

RESULTS

Among patients who underwent PD-CHAR, there was no severe morbidity. Artery/portal vein combined resection and reconstruction was performed in all patients. Four (44%) patients had pathological positivity for cancer cell invasion into the nerve plexus of artery at the site of radiographic artery involvement, although one (11%) was diagnosed with pathological artery involvement.

CONCLUSION

PD-CHAR following neoadjuvant therapy might be feasible for PNBC without severe postoperative complications. Survival benefits in PNBC should be confirmed in further studies.

Reconstruction of the hepatic artery using the superior mesenteric artery for liver transplantation

Background

To investigate the application of the superior mesenteric artery (SMA) for the in vitro reconstruction of the hepatic artery for liver transplantation, and to improve the success rate and safety of donor liver transplantation.

Methods

The donor liver and the pancreas were obtained, and the SMA and its branches were used to reconstruct the hepatic artery. Liver transplantation was performed after reconstruction to understand the intraoperative situation after donor liver opening, as well as postoperative liver function. Color Doppler ultrasound of the transplanted liver was also performed.

Results

During the period from September 2016 to March 2020, a total of 98 pancreases were obtained. The common hepatic artery and gastroduodenal artery loop (CHA-GDA) were preserved to the donor pancreas, and only the proper hepatic artery (PHA) or left/right hepatic artery (LHA/RHA) were preserved to the donor liver. If the PHA of the donor liver was short or absent, the SMA was used for lengthening the PHA or in vitro reconstruction of the LHA/RHA, followed by implantation of the donor liver after reconstruction. A total of 17 cases of this type of donor liver required mesenteric artery lengthening or reconstruction. After opening, the donor liver was well-filled, bile secretion was normal, and liver function recovered as scheduled after surgery. Color Doppler ultrasound and CT angiography (CTA) of the transplanted liver revealed that hepatic arteries were normal without complications such as hepatic artery embolism.

Conclusions

In vitro reconstruction of the hepatic artery with the SMA is an effective new method of vascular reconstruction, which ensures the blood flow of the hepatic artery, reduces the anastomosis difficulty of the arteries of the donor liver, and reduces the occurrence of vascular complications.

A comparative study of methods used to generate the arterial fiber structure in a clinically relevant numerical analysis

The advanced constitutive material models of artery wall require the definition of the mean collagen fiber directions in the material configuration. There are several proposed methods; however, it is unclear how much does the fiber structures obtained by these methods differ one from the other and how much this difference may affect the results of the structural analysis of a clinically relevant scenario. Therefore, in this paper, we address this issue by presenting the results of the comparative study of our developed and currently state-of-the-art fiber definition methods. In addition, we present the verification of our developed numerical model that incorporates the extended Holzapfel-Gasser-Ogden (HGO) constitutive material model and the generalized prestressing algorithm (GPA). In the case of the patient-specific internal carotid artery (ICA), the percentage error of the mean fiber directions defined by different methods does not exceed 17.73% (at least 0.05%, at most 81.82%) and has negligible effect on the stress levels, as the percentage error of the mean circumferential Cauchy stress does not exceed 0.1%. Both fiber definition methods produce comparable fiber structure, but our proposed method has an advantage, as it does not depend on method and software used to model the arterial wall mechanics.