Results of surgical treatment of patients with cancer of the pancreatic body and tail and invasion of the celiac trunk

Aim. To demonstrate relative safety, marked pain releif effect and satisfactory long-term results of surgical treatment of patients with ductal carcinoma of the pancreatic body and tail with invasion of the celiac trunk in the form of distal subtotal pancreatic resection (DSPR) with resection of the celiac trunk.
Materials and methods. The retrospective study included patients with cancer of the pancreatic head and tail with invasion of the celiac trunk who underwent DSPR with resection of the celiac trunk at the N . N . Blokhin National Medical Research Center of Oncology in 2001–2023. Surgical complications were evaluated per the Clavien–Dindo classification. At the preoperative stage, angiography was performed to thoroughly evaluate the condition of the collateral system between the superior mesenteric and common hepatic arteries. According to the criteria we developed during this study, patients with undeveloped collaterals underwent preoperative embolization of the common hepatic artery with metallic spirals preserving blood flow through the gastroduodenal artery. Considering patients’ complaints of local pain of varying intensity at hospitalization, we evaluated their pain syndrome using the V isual Analogue Scale (VAS) before and after surgical treatment.
Results. DSPR with resection of the celiac trunk and common hepatic artery was performed in 32 patients. In 8 (25 %) of them, due to undeveloped arterial collaterals between the systems of the superior mesenteric and hepatic arteries, 7–14 days prior to surgery embolization of the common hepatic artery was performed with preservation of blood flow through the gastroduodenal artery. In 18 (56.25 %) patients, superior mesenteric and / or portal veins invaded by the tumor were resected along with the celiac trunk. In 84.4 % of cases, the volume of surgical treatment was R0; in 9.4 % of cases, R1; in 6.2 % of cases, R2. Frequency of histologically confirmed invasion of the celiac trunk was 78.1 %, magistral veins 72.2 %, perineural invasion 90.6 %. A correlation (r = 0.55; р = 0.001) between the presence of perineural invasion and local pain at the preoperative stage was observed. Mean pain syndrome intensity per VAS in patients with perineural invasion was 7.3 points which was significantly (р = 0.000001) higher than in patients without perineural invasion (2.7 points). DSPR with resection of the celiac trunk and nerve dissection relieved pain syndrome in all patients. Complications after DSPR with resection of the celiac trunk were observed in 17 (53.1 %) patients, in 14 (43.7 %) their severity was grade III or higher per the Clavien–Dindo scale. Mortality was 6.3 %. Oneand 2‑year survival of patients with locally advanced ductal carcinoma of the pancreatic body and tail after DSPR with resection of the celiac trunk were 65.2 and 10.2 %, respectively, median overall survival was 15 months, maximal lifespan was 57 months. One- and 3‑year survival without signs of progression was 46.2 and 8.8 %, respectively, median progression-free survival was 9.9 months.
Conclusion. DSPR with resection of the celiac trunk and common hepatic artery is relatively safe, allows to relieve pain syndrome with significant improvement in the quality of life of the patients, and promotes longer survival.