Strategies to prevent, mitigate and manage complications of celiac trunk stenosis in patients undergoing pancreatectomy. A retrospective multicentre series.

Background: Celiac axis stenosis (CAS) may increase post-pancreatectomy complication risks, but its prevalence and impact on major morbidity are not fully understood. Despite various trials on surgical techniques to reduce POPF, none have shown definitive risk reduction. Objective: To evaluate CAS as a risk factor for postoperative complications following pancreatectomy and to identify treatment protocols based on CAS severity. Methods: We analyzed a retrospective cohort of patients undergoing PD or TP over three years at four HPB centers. CAS severity was assessed via preoperative CT and categorized as no stenosis (<30%), grade A (30%-50%), grade B (50%-80%), and grade C (>80%). Postoperative complications were summarized using the Clavien-Dindo classification, with risk analyses conducted. Results: since data collection from some HPB centers is still ongoing and certain data on CAS severity classes are incomplete, the relationship between celiac axis stenosis (CAS) and postoperative outcomes was analyzed based on the presence or absence of stenosis ≥30%. CAS was significantly associated with an increased risk of clinically relevant POPF (grades B or C), as well as liver failure. Patients with CAS had higher cumulative complication scores, reoperation rates, and completion pancreatectomies. Ligament dissection in CAS grade B cases resulted in mild liver failure and moderate complication scores, while arterial reconstruction in a grade C case resulted in moderate liver failure and a high complication score. Preoperative stenting in CAS grade B or C cases generally led to mild complication scores, while postoperative stenting in CAS grade B resulted in moderate-to-severe scores. Conclusions: CAS is linked to higher rates of clinically relevant POPF, reoperation, completion pancreatectomy, liver perfusion failure, and Clavien-Dindo scores, indicating an increased risk of major morbidity. Preoperative CAS assessment is recommended. Concerning mitigation strategies, the limited sample size of patients collected thus far precludes drawing definitive conclusions at this stage of data collection.