LIVER AND STOMACH COLLATERAL BLOOD SUPPLY AFTER DISTAL PANCREATECTOMY WITH CELIAC ARTERY RESECTION. IO US AND ICG GASTROSCOPY ARE MORE USEFUL TOOLS THAN PREOP COMMON HEPATIC ARTERY OCCLUSION: EXPERIENCE OF 115 CHA CLAMPING AND 26 DP CARS

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Background. Distal pancreatectomy with celiac artery resection (DPCAR) is in use for borderline-resectable pancreatic cancer. It is believed that considerable reduction of the liver arterial supply after DPCAR may cause severe liver ischemia. Decision to reconstruct СHA or left gastric has to be justified. Aim. To study stomach’s and liver’s collateral arterial supply after common (CHA and celiac artery (CA) temporary occlusion. Material and Methods. Arterial anatomy, diameters of CHA, proper hepatic, gastroduodenal and pancreatoduodenal arcades (PDA) were registered before surgery in 115 consecutive patients with pancreatic body/tail cancer (n36), gastric cancer with pancreatic involvement (n30) and liver tumors (n45) by CT. For DPCAR (n26) patients ICG gastroscopy or CT were performed during or after surgery. Arterial blood flow in the liver and mean systolic velocity in hepatic arteries before and after clamping were measured intraoperatively by US. Results and Discussion. Classical arterial anatomy was identified in 67%. Pulse disappeared in 9 (8%) cases after clamping of CHA, RGEA and aLHA/rLPA. Collateral arterial blood flow in the liver parenchyma was preserved in all cases. DPCAR led to increase of GDA, PDA and RGEA blood flow in 1-12 times; PDA were detected only once before DPCAR. Gastric ischemia was revealed in four and liver ischemia in 0 cases. Conclusions. 1. IOUS is a reliable modality for intraoperative assessment of liver arterial blood supply during DPCAR. 2. Gastric ischemia is much more frequent event than liver ischemia after CA occlusion. IO ICG gastroscopy can be the option for the reconstruction of left gastric artery. 3. CHA occlusion before DPCAR is unnecessary procedure.