Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study

Klompmaker, Sjors; Hilst, Jony van; Gerritsen, Sarah; Adham, Mustapha; Quer, M; Bassi, Claudio; Berrevoet, Frederik; Boggi, Ugo; Busch, Olivier R.; Cesaretti, Manuela; Valle, Raffaele Dalla; Darnis, Benjamin; Pastena, Matteo De; Chiaro, Marco Del; Grützmann, Robert; Diener, Markus K.; Dumitraşcu, Traian; Frieß, Helmut; Ivanecz, Arpad; Karayiannakis, Anastasios J.; Fusai, Giuseppe; Labori, Knut Jørgen; Lombardo, Carlo; López‐Ben, Santiago; Mabrut, Jean‐Yves; Niesen, Willem; Pardo, Fernando; Périnel, Julie; Popescu, Irinel; Roeyen, Geert; Sauvanet, Alain; Prasad, Raj; Sturesson, Christian; Lesurtel, Mickaël; Kleeff, Jörg; Salvia, Roberto; Besselink, Marc G.

doi:10.1245/s10434-018-6391-z

Cited by 80 publications

(60 citation statements)

References 32 publications

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“…In a recent retrospective international multicenter study including 191 patients undergoing DP‐CAR, the 90‐day mortality rate was 5.5% at five high‐volume but as high as 18% at 18 low‐volume DP‐CAR centers, demonstrating the importance of experience with this rare and complex procedure . In a multicenter study performed in 20 European centers in 12 countries, the median survival of 68 patients undergoing DP‐CAR was 18 months . A recent single‐center study reported a very favorable median survival of 38.6 months with a strategy of neoadjuvant therapy followed by DP‐CAR in pancreatic cancer with celiac axis involvement, recommending a neoadjuvant strategy in these patients .…”

Section: Surgical Techniques To Increase Local Radicality In Pancreatmentioning

confidence: 99%

Local radicality and survival outcome of pancreatic cancer surgery

Niesen

Hank

Büchler

et al. 2019

Annals of Gastroent Surgery

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Pancreatic cancer remains a therapeutic challenge. Surgical resection in combination with systemic chemotherapy is the only option promising long‐term survival and potential cure. However, only about 20% of patients are diagnosed with tumors that are still in a resectable stage. Even after potentially curative resection and modern regimens for adjuvant chemotherapy, the majority of patients develop local and systemic recurrence resulting in median overall survival times of 28‐54 months. The predominance of systemic recurrence and its impact on survival may lead to the assumption that surgical radicality and local control play only minor roles in the treatment of pancreatic cancer. This review provides an overview of the recent literature on surgical radicality and survival outcome in pancreatic cancer. The current evidence on the extent of lymphadenectomy, the prognostic impact of the extent of lymph node involvement, and the impact of the resection margin status on postresection survival are reviewed. Data from recent studies performed in the context of modern surgery and adjuvant therapy provide good evidence of a considerable impact of local radicality on survival after pancreatic cancer surgery. Surgical techniques that have been developed to refine oncological resections and to increase local control as well as resectability are highlighted. These techniques include artery‐first approaches, level‐3 dissection with removal of the periarterial nerve plexus, the triangle operation, and extended resections. Local radicality and quality of surgical resection remain among the most important parameters that determine the chances for survival in patients with non‐metastatic pancreatic cancer.

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Section: Surgical Techniques To Increase Local Radicality In Pancreatmentioning

confidence: 99%

Local radicality and survival outcome of pancreatic cancer surgery

Niesen

Hank

Büchler

et al. 2019

Annals of Gastroent Surgery

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“…Historically, in our institution, vascular involvement has not been deemed an absolute contraindication for resection [6,[11][12][13][14].We started with vein resection and, after some experience, we evolved to resect also arterial segments (P-Ar). Initially, arterial resection was considered when technically feasible.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

et al. 2020

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Pancreatectomy with arterial resection is a treatment option in selected patients with locally advanced pancreatic cancer. This study aimed to identify factors predicting cancer-specific survival in this patient population. A single-Institution prospective database was used. Pre-operative prognostic factors were identified and used to develop a prognostic score. Matching with pathologic parameters was used for internal validation. In a patient population with a median Ca 19.9 level of 19.8 U/mL(IQR: 7.1–77), cancer-specific survival was predicted by: metabolic deterioration of diabetes (OR = 0.22, p = 0.0012), platelet count (OR = 1.00; p = 0.0013), serum level of Ca 15.3 (OR = 1.01, p = 0.0018) and Ca 125 (OR = 1.02, p = 0.00000137), neutrophils-to-lymphocytes ratio (OR = 1.16; p = 0.00015), lymphocytes-to-monocytes ratio (OR = 0.88; p = 0.00233), platelets-to-lymphocytes ratio (OR = 0.99; p = 0.00118), and FOLFIRINOX neoadjuvant chemotherapy (OR = 0.57; p = 0.00144). A prognostic score was developed and three risk groups were identified. Harrell’s C-Index was 0.74. Median cancer-specific survival was 16.0 months (IQR: 12.3–28.2) for the high-risk group, 24.7 months (IQR: 17.6–33.4) for the intermediate-risk group, and 39.0 months (IQR: 22.7–NA) for the low-risk group (p = 0.0003). Matching the three risk groups against pathology parameters, N2 rate was 61.9, 42.1, and 23.8% (p = 0.04), median value of lymph-node ratio was 0.07 (IQR: 0.05–0.14), 0.04 (IQR:0.02–0.07), and 0.03 (IQR: 0.01–0.04) (p = 0.008), and mean value of logarithm odds of positive nodes was − 1.07 ± 0.5, − 1.3 ± 0.4, and − 1.4 ± 0.4 (p = 0.03), in the high-risk, intermediate-risk, and low-risk groups, respectively. An online calculator is available at www.survivalcalculator-lapdac-arterialresection.org. The prognostic factors identified in this study predict cancer-specific survival in patients with locally advanced pancreatic cancer and low Ca 19.9 levels undergoing pancreatectomy with arterial resection.

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“…Arterial resections during pancreatectomies were proven to be technically feasible (30)(31)(32)(33), but the rate of postoperative complications including postoperative mortality is high (34,35), with highly controversial oncological benefits for patients with PDAC (33,34). Resection of combined PV/ SMV resection with superior mesenteric artery resection during pancreatectomies for PDAC were associated with up to 91% morbidity rates and 20% mortality rates, as a recent systematic review has shown (34).…”

Section: Discussionmentioning

confidence: 99%

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

Dumitraşcu¹,

Martiniuc²,

Brasoveanu³

et al. 2018

chr

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Invasion of portal vein (PV)/ superior mesenteric vein (SMV) in pancreatic ductal adenocarcinoma (PDAC) is no longer a contraindication for resection when reconstruction is technically feasible. However, the literature data reached conflicting conclusions regarding the early and long-term outcomes of patients with venous resection and pancreatectomies for PDAC. The study aims to present the outcomes in a large series of patients with pancreatectomies and associated PV/ SMV resection for PDAC, in a single center experience. The data of 100 patients with pancreatectomies and PV and/ or SMV resection performed between 2002 and 2016 (February, 1st) were retrospectively analyzed from a prospectively maintained electronic database, which included 474 pancreatectomies for PDAC. Only patients with a final pathological diagnosis of PDAC were included in the present study. Overall, 21.1% of patients with pancreatectomies for PDAC required a venous resection (100 patients out of 474 patients). Segmental resection was performed in 77 patients (out of 100 patients with pancreatectomies and venous resection - 77%), while 23 patients (23%) have had tangential venous resection. In the group of patients with segmental venous resection, reconstruction was made by end-to-end anastomosis in 53 patients (out of 77 patients - 68.8%), while in 24 patients (out of 77 patients - 31.2%) a graft interposition was necessary. Negative resections margins were obtained in 63 patients (63%). Histological tumor invasion of the resected vein was confirmed in 64 patients (64%). Postoperative complications occurred in 47 patients (47%), with severe complications (i.e., Dindo-Clavien grade III-V) in 19 patients (19%). Postoperative pancreatic fistulae, delayed gastric emptying and post-pancreatectomy hemorrhage rates were 9%, 20% and 15%, respectively. PV/ SMV thrombosis occurred in 5 patients (5%). The 90-day mortality rate in the group of patients with venous only resection, without any associated procedures, was 8%. Adjuvant treatment was performed in 63 patients (63%), while only 2 patients (2%) underwent neoadjuvant chemotherapy. Median follow-up time was 105 months (range, 3 - 186 months), with a median overall survival time of 13 months (range, 3 - 186 months). In the group of patients with negative resection margins, the median overall survival time was 16 months (range, 3 - 186 months). PV/ SMV resection during pancreatectomies for PDAC is technically feasible, and grafts are rarely required for venous reconstruction. However, venous resection is associated with high postoperative complications rates, and the mortality rate is not neglectable. The main goal of such complex procedure is to obtain negative resection margins, a situation associated with encouraging survival rates.

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Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study

Cited by 80 publications

References 32 publications

Local radicality and survival outcome of pancreatic cancer surgery

Local radicality and survival outcome of pancreatic cancer surgery

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

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