Laparoscopic Common Hepatic Artery Ligation before Left Pancreatectomy with Celiac Artery Resection

Introduction: The best method and the exact benefit of liver preconditioning before pancreatectomy with en-bloc celiac axis resection (CAR) remain debated. We report our experience with preoperative laparoscopic common hepatic artery ligation (HAL) compared to arterial embolization. Method: From May 2014 to July 2021, 17 patients underwent distal pancreatectomy and CAR for pancreatic adenocarcinoma of the body–tail, after neoadjuvant FOLFIRINOX. Nine patients underwent preoperative laparoscopic HAL and six underwent coil embolization in interventional radiology (CE). Results: The median progression-free survival and overall survival rates after CAR were 11 months and 31.9 months respectively. The 90-day mortality rate was 11.8% (n=2). Major postoperative complication rate was 29.4%. In the CE group, gastric ischemia and fistula were found in one patient versus none in the HLA group. Postoperative liver infarction developed only in one patient, in the CE group. Median delay before surgery were 16 and 23 days for CE and HAL groups, respectively. No differences in terms of per- or postoperative outcomes was found between groups. Conclusions: Preoperative laparoscopic hepatic artery ligation is a safe, efficient and feasible procedure in the preoperative management of celiac trunk before CAR. It could be added to a laparoscopic exploration for oncologic reason before planning this highly risky surgery.