[Two Cases of Remnant Pancreatic Cancer Treated Using Remnant Pancreatectomy Combined with Hepatic Arterial Resection].

Case 1: A 40-year-old man was diagnosed with remnant pancreatic cancer invading the celiac axis 8 months after pancreaticoduodenectomy for pancreatic head cancer. As his gastroduodenal artery had been resected, the patient underwent preoperative coil embolization of the common hepatic artery for the development of extrahepatic collaterals. Eighteen days after the coil embolization, remnant pancreatectomy combined with celiac axis resection without reconstruction was performed. The patient was discharged without postoperative hepatic complications. Case 2: A 62-year-old woman was diagnosed with remnant pancreatic cancer 13 months after distal pancreatectomy with celiac axis resection for pancreatic body cancer. As the coil that had accidentally migrated to the proper hepatic artery during preoperative coil embolization for initial surgery remained, the flow to the liver through the gastroduodenal artery had weakened. In contrast, collateral flow from the right inferior phrenic artery to the right hepatic artery had increased. Remnant pancreatectomy with gastroduodenal artery resection was performed with no postoperative hepatic complications. Changes in the hemodynamics of the liver, resulting from preoperative coil embolization, may reduce the risk of postoperative hepatic ischemia after remnant pancreatectomy combined with hepatic arterial resection.