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

Valentin Artaud, Xavier Giudcelli, Laurent Sulpice

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Valentin Artaud, Xavier Giudcelli, Laurent Sulpice. Class IA Pancreatosplenectomy with Class IA Celiac Axis Resection, SMA Isolation, and Lateral Venous Reconstruction with Peritoneal Patch: A Standardized Technique. Annals of Surgical Oncology, 2026, 10.1245/s10434-026-19094-2. hal-05509387

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Submitted on 13 Feb 2026

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

Valentin Artaud, MD<fnref n="1" />, Xavier Giudcelli, MD<fnref n="1" />, and Laurent Sulpice, MD, PhD<fnref n="2" />

**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.<fnref n="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 colateral circulation and reduce postoperative morbidity.<fnref n="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.

**SUPPLEMENTARY INFORMATION** The online version contains supplementary material available at https://doi.org/10.1245/s10434-026-19094-2.

**FUNDING** Open access funding provided by Centre Hospitalier Universitaire de Rennes.

**DISCLOSURE** The authors declare no conflicts of interest for this video.

**OPEN ACCESS** This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

<footnote n="1">¹Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France;</footnote>

<footnote n="2">²INSERM U1242, Chemistry Oncogenesis Stress Signaling, CHU Pontchaillou, Université de Rennes 1, Rennes, France</footnote>
REFERENCES

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https://doi.org/10.1016/j.jamcollsurg.2020.05.005.

2. De Crignis L, Garnier J, Ewald J, et al. Preoperative liver arterial conditioning in patients scheduled for a Mayo Clinic class IA distal pancreatectomy: Embolization or ligation? *HPB*. 2023;25(4):439–45. https://doi.org/10.1016/j.hpb.2023.01.007.

3. Abo D, Hasegawa Y, Sakuhara Y, et al. Feasibility of a dual microcatheter-dual interlocking detachable coil technique in pre-operative embolization in preparation for distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer. *J Hepatobiliary Pancreat Sci*. 2012;19(4):431–7.
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