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. 2024 Dec;130(8):1573-1578.
doi: 10.1002/jso.27796. Epub 2024 Aug 4.

Celiac artery stenosis and its impact on postoperative outcomes following pancreaticoduodenectomy: An institutional analysis

Shamsher A Pasha  1 , Abdullah Khalid  1 , Julia Arena  2 , Ahmadreza Alizadeh  2 , Jeffrey Levine  2 , Lyudmyla Demyan  1 , Gary Deutsch  1 , Matthew J Weiss  1 , Elliot Newman  2 , Marcovalerio Melis  2
Affiliations

Celiac artery stenosis and its impact on postoperative outcomes following pancreaticoduodenectomy: An institutional analysis

Shamsher A Pasha et al. J Surg Oncol. 2024 Dec.

Abstract

Background: The detection of a stenotic celiac artery (CA) typically mandates intraoperative revascularization during pancreaticoduodenectomy (PD) to preserve liver perfusion. The impact of CA stenosis on postoperative outcomes is unclear. This study evaluates whether CA stenosis (CAS) is associated with increased postoperative complications.

Methods: We conducted a retrospective analysis of PD patients from February 2014 to February 2022. Preoperative imaging assessed the CA lumen, categorizing it as patent, <50%, or ≥50% stenosis. Patients with narrowed SMA were excluded. Complications were categorized using the Clavien-Dindo system, and statistical analyses identified outcome differences.

Results: We included 427 patients in the study. Of these, 52 had CAS, and 311 had no-vessel stenosis (NVS). The median age of the CAS and NVS groups was 68 and 65 years, respectively. Postoperatively, 17.6% of patients with CAS exhibited delayed gastric emptying (DGE) versus 25.3% in the NVS group. Postoperative pancreatic fistula (POPF) was found in 13.5% of patients with CAS, compared with 23.7% without stenosis. The median length of hospital stay was shorter for patients with CAS (9 days) than for those with CAS (12 days). Severity-based classifications indicated higher complications in the no stenosis group and a 33.0% readmission rate within 30 days compared with 21.2% in CAS patients. However, none of these differences were statistically significant.

Conclusions: Critical stenosis of the CA does not significantly affect postoperative outcomes following PD, suggesting preoperative correction of the narrowed CA may not be necessary. Further research is needed to confirm these findings.

Keywords: celiac artery stenosis; intraoperative revascularization; pancreaticoduodenectomy; postoperative complications; vascular management.

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