Distal pancreatectomy with en bloc celiac axis resection for pancreatic body-tail cancer: Is it justified?

Abstract

BackgroundThe aim of this study was to evaluate the safety and efficacy of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for pancreatic body-tail cancer.Material/MethodsThe medical records of 12 patients who underwent DP-CAR for pancreatic body-tail cancer were retrospectively studied, together with a literature review of studies including at least 3 cases of DP-CAR.ResultsThere were no deaths among our 12 cases. Postoperative morbidity developed in 9 cases and was successfully managed by non-surgical treatment. No patients developed ischemic complications. Median overall survival was 10 months. A total of 19 studies involving 203 patients who underwent DP-CAR were included in the literature review. The overall morbidity and mortality rates were 50.2% and 3.0%, respectively. The overall median survival after surgery ranged from 9.3 to 26 months.ConclusionsDP-CAR is a safe and effective treatment for patients with locally advanced pancreatic body-tail cancer.

Distal Pancreatectomy With En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Cancer

“…Seven studies 4,9,13,27,28,30,31 including 114 patients undergoing DP-CAR reported intraoperative blood loss. The mean blood loss varied from702 mL to 1867.5 mL.…”

Neoadjuvant therapy in pancreatic cancer: what is the true oncological benefit?

“…Consistent with these results, Sonohara et al demonstrated that PCa patients with AR had marginally higher recurrence-free survival and longer overall survival without a significant increase in the incidence of severe postoperative complications [33]. Current studies evaluating celiac artery resection also showed that these procedures can be performed safely and with an encouraging median survival [32,34]. Further analyses suggested the improvement to be a consequence of newly developed and more effective chemotherapeutical regimens used in neoadjuvant settings.…”

“…In the first meta-analysis evaluating AR in patients undergoing pancreatectomy for PCa, AR was discouraged as standard of care and was associated with remarkably higher perioperative morbidity (OR = 2.17) and mortality (OR = 5.04) and poor survival (OR = 0.50) [4]. Conversely, in a recent study, Del Chiaro et al demonstrated the feasibility and safety of AR in pancreatectomy, which was accompanied by increased survival compared with palliative procedures and showed no difference in postoperative mortality and morbidity, even though it was associated with longer operation time and higher blood loss [31,32]. Consistent with these results, Sonohara et al demonstrated that PCa patients with AR had marginally higher recurrence-free survival and longer overall survival without a significant increase in the incidence of severe postoperative complications [33].…”

Distal pancreatectomy with celiac axis resection (DP-CAR): Optimal perioperative outcome in a patient with locally advanced pancreas adenocarcinoma

“…In the literature, liver ischemic complications vary a lot: 0–62% [ 1 , 2 , 4 , 7 , 11 , 17 , 18 ], but seem to be around 20% in the larger studies [ 1 , 4 , 7 ]. Ischemic gastropathy is also not infrequent, ranging from nil [ 11 , 18 ] to 29% [ 9 ], but generally occurs in around 10% of patients [ 1 , 2 , 12 , 17 ]. Few authors emphasize the need for preservation, or reconstruction of the left gastric artery [ [17] , [18] , [19] ], whereas most others have not found the need for it.…”

“…DP-CAR is generally associated with significant mortality and morbidity, much higher than “straightforward” pancreatoduodenectomy, or DP, even in experienced hands. Mortality is reported around 10% [ 1 , 2 , 4 , 5 ] and varies between 3.5% and 18% [ 3 , [6] , [7] , [8] , [9] ], although nil mortality has also been documented [ [10] , [11] , [12] ]. Median survival after DP-CAR is generally less than 20 months [ 1 , 2 , 4 , 6 ], but this may reflect older experience before neoadjuvant chemotherapy (NAC) was the rule for locally advanced PC.…”