A case of pancreas head cancer undergoing pancreatoduodenectomy with combined resection and reconstruction of the anomalous common hepatic artery

Abstract

A 57-year-old man with obstructive jaundice was referred to our hospital. Endoscopic retrograde cholangiography showed stenosis and left-sided deflection of the lower bile duct, and biopsy revealed adenocarcinoma. Enhanced abdominal CT revealed a low density tumor in the head of the pancreas surrounding the anomalous common hepatic artery (CHA), deriving from the hepatomesenteric arterial trunk. Cancerous invasion to the CHA and portal vein was suspected. The patient underwent pancreatoduodenectomy with resection and reconstruction of CHA and the portal vein. The proper hepatic artery was anastomosed with the descending branch of the left gastric artery. Microscopic examination of the resected specimen showed invasive ductal adenocarcinoma of the head of the pancreas, T4N1M0, Stage IVa according to the Japanese General Rules Classification. S-1 adjuvant chemotherapy was performed after surgery, and he has survived over 5 years without recurrence. In general, invasion to the common hepatic artery is considered a contraindication for resection of pancreas head cancer. We performed resection and reconstruction of the anomalous common hepatic artery with pancreatoduodenectomy for pancreas head cancer, which resulted in longer survival. © 2014 The Japanese Society of Gastroenterological Surgery.