Class IA Pancreatosplenectomy with Class IA Celiac Axis Resection, SMA Isolation, and Lateral Venous Reconstruction with Peritoneal Patch: A Standardized Technique

Abstract Surgical treatment of pancreatic tumors invading the celiac axis is increasingly performed following induction therapy. This generally consists of a pancreatosplenectomy with celiac axis resection. When performed without revascularization, it is classified as IA. 1 This video presents a 52-year-old patient with no medical history, in whom a pancreatic body mass was incidentally discovered. Imaging revealed a locally advanced lesion involving the celiac axis, contacting the superior mesenteric artery and the portal–mesenteric confluence. Biopsies were noncontributory, CA 19-9 was normal, and the staging workup was negative. After multidisciplinary discussion, induction therapy was recommended. The patient received 12 courses of FOLFIRINOX followed by 50.4 Gy radiochemotherapy with capecitabine. In the absence of progression, surgical resection was undertaken. Preoperative hepatic and left gastric artery embolization was performed to promote collateral circulation and reduce postoperative morbidity. 2,3 A distal splenopancreatectomy with celiac axis resection, full isolation of the superior mesenteric artery, and lateral resection of the portal–mesenteric axis including the splenic vein origin were performed. Venous reconstruction was achieved using a peritoneal patch. The procedure was uneventful, and postoperative recovery was uncomplicated. Locally advanced pancreatic body tumors involving the celiac trunk and/or superior mesenteric artery may be suitable for resection after optimal neoadjuvant therapy and preoperative vascular conditioning. Such complex procedures require a multidisciplinary approach and should be performed in specialized pancreatic surgery centers with interventional radiology expertise in selective embolization.