Survival impact of distal pancreatectomy with en bloc celiac axis resection combined with neoadjuvant chemotherapy for borderline resectable or locally advanced pancreatic body carcinoma

Murakami, Yoshiaki; Nakagawa, Noritoshi; Kondo, Naru; Hashimoto, Yasushi; Okada, Kenjiro; Seo, Shingo; Otsuka, Hiroyuki

doi:10.1016/j.pan.2021.01.008

Cited by 10 publications

(12 citation statements)

References 37 publications

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“…According to the Clavien–Dindo classification 35 , perioperative morbidity rates of patients with AR and NAT were reported in six studies including 116 patients and ranged from 30 to 100% (median 54%) 16 , 22 , 24 – 26 , 33 . The pooled morbidity rate was 60% (95% CI: 40–79%; I ²=75.9%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity analysis confirmed the robustness of the findings, while neither the funnel plot nor Egger’s test provided evidence of publication bias ( P >0.05). Subgroup analyses indicated that studies with a sample size greater than 30 and study quality greater than or equal to 7 exhibited slightly lower morbidity rates (52.9%, 95% CI: 40.9–64.6%; 56.3%, 95% CI: 26.8–94.6%) 16 , 24 compared to those with smaller samples and lower quality (64.3%, 95% CI: 26.8–94.6%; 61.1%, 95% CI: 34.1–85.2%) 22 , 25 , 26 , 33 (Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, both the funnel plot and Egger’s test demonstrated no evidence of publication bias ( P =0.234>0.05). In the subgroup analysis, four articles with a sample size greater than 30 was included to investigate postoperative mortality 16 , 21 , 23 , 24 (Table 5 ). The results showed that the mortality rate (0.9%; 95% CI: 0.0–4.5%) was lower compared to those with smaller sample sizes (9.7%; 95% CI: 0.2–26.6%) 22 , 25 , 33 .…”

Section: Resultsmentioning

confidence: 99%

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Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

Xue,

Huang,

Zhao

et al. 2023

International Journal of Surgery

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Background: Pancreatic cancer frequently involves the surrounding major arteries, preventing surgeons from making a radical excision. Neoadjuvant therapy (NAT) can lessen the size of local tumors and eliminate potential micrommetastases. However, systematic and evidence-based recommendations for the treatment of arterial resection (AR) after NAT in pancreatic cancer are scarce. Method: A computerized search of the Medline, Embase, Cochrane Library databases, and Clinicaltrials was performed to identify studies reporting the outcomes of patients who underwent pancreatectomy with AR and NAT for pancreatic cancer. Studies that reported perioperative and/or long-term results after pancreatectomy with AR and NAT were eligible for inclusion. The quality of the evidence was assessed with Newcastle–Ottawa Quality Assessment Form of bias tool. Data were pooled and analyzed by Stata 14.0 software. Result: Nine studies with an overall sample size of 215 met our eligibility criteria and were included in the meta-analysis. All studies were retrospective studies, and the methodological quality was moderate. The pooled morbidity and mortality rates were 51% (95% CI: 41–61%; I²= 0.0%) and 2% (95% CI: 0–0.08; I²=33.3%), respectively. Meta-analysis showed that the overall R0 resection rate was 79% (CI: 70–86%, I²=15.5%). Comparative data on R0 rates of patients who underwent pancreatectomy with and without NAT showed a significant difference in favor of the former group with moderate statistical heterogeneity (Relative risk=1.21; 95% CI: 0.776–1.915; I²=48.0%). The median 1-, 2-, 3-, and 5-year survival rates of patients who had AR were 92.3% (range: 72.7–100%), 64.8% (range: 25–78.8%), 51.6% (range: 16.7–63.6%), and 14% (range: 0–41.1%), respectively. Data on median progression-free survival ranged from 5.25 to 36.3 months, and the median overall survival ranged from 17 to 44.9 months. Conclusions: Pancreatectomy with major AR following NAT has the potential to enhance the survival rate of patients with unresectable pancreatic cancer involving the arteries by achieving R0 resection, despite a significant risk of postoperative complications. However, to validate the feasibility and effectiveness of this procedure, prospective controlled studies are necessary to address limitations arising from small sample sizes and potential biases inherent in retrospective studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

Xue,

Huang,

Zhao

et al. 2023

International Journal of Surgery

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“…As the procedure was applied to pancreatic cancer, surgeons tried to preserve the stomach based on the existence of collateral blood flow [11]. A series of previous studies reported the feasibility of DP-CAR, particularly in patients with neoadjuvant and adjuvant chemotherapy for BRPC or LAPC [6,7,[12][13][14][15][16][17][18]. However, the procedure could be accompanied by specific and sometimes fatal complications, as well as hepatic and gastric ischemia, and only limited data are available on the prevention and management of these adverse events.…”

Section: Discussionmentioning

confidence: 99%

15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer—A Korean Nationwide Investigation

Yoon,

Park,

Yoon

et al. 2023

Cancers

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Background: As systemic treatment for pancreatic cancer advances, distal pancreatectomy with celiac axis resection (DP-CAR) has been considered a curative-intent surgical option for advanced pancreatic cancer. This study aimed to review the surgical and oncologic outcomes of patients undergoing DP-CAR based on Korean nationwide data. Methods: We collected the data of patients who underwent DP-CAR for pancreatic cancer between 2007 and 2021 at seven major hospitals in Korea. The clinicopathological characteristics, postoperative complications, and data on the survival of the patients were retrospectively reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications and survival. Results: A total of 75 patients, consisting mainly of borderline resectable (n = 32) or locally advanced (n = 30) pancreatic cancer, were included in the analysis. Forty-two (56.0%) patients underwent neoadjuvant treatment (NAT). Twenty (26.7%) patients experienced Clavien–Dindo grade ≥ 3 complications, including four patients with ischemic gastropathy, two with hepatic ischemia, and two procedure-related mortalities. Neoadjuvant chemotherapy increased the risk of postoperative complications (p = 0.028). The median recurrence-free and overall survival were 7 and 19 months, with a 5-year survival rate of 13% and 24%, respectively. In the NAT group, a decrease in CA 19-9 and the post-NAT maximum standardized uptake value (SUVmax) in positron emission tomography were associated with survival after surgical resection. Conclusions: Despite the possibility of major complications, DP-CAR could be a feasible option for achieving curative resection with fair survival outcomes in patients with borderline resectable or locally advanced pancreatic cancer. Further studies investigating the safety of the procedure and identifying proper surgical candidates with potential survival gains are necessary.

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“…The term “borderline resectable” pancreatic adenocarcinoma (BR-PDCA) refers to a disease with major venous involvement and/or arterial abutment on thin-slice cross-sectional imaging (31) . Based on this concept of categorization, numerous rigorous clinical trials of BR-PDCA have been designed (32) , (33) . This term should also be adopted in the field of HCC as borderline resectable-HCC (BR-HCC).…”

Section: _borderline Resectable-hccmentioning

confidence: 99%

Hepatic Resection for Hepatocellular Carcinoma in the Era of Molecular-targeted Agents and Immune Checkpoint Inhibitors in Japan

Taketomi

2021

JMA J

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Hepatic resection or liver transplantation for hepatocellular carcinoma (HCC) represents the only chance for achieving a cure. For the past several decades in Japan, aggressive hepatic resection has been performed for advanced HCC, with consequent good outcomes. According to the 21st Nationwide Follow-Up Survey of Primary Liver Cancer in Japan, 38.3% of patients were treated with hepatic resection or liver transplantation as the initial treatment. The median overall survival of patients who underwent surgery was 57.0 months, and the 5- and 10-year survival rates were 48.4% and 25.2%, respectively. Since 1964, a total of 10,038 liver transplants (595 deceased-donor and 9,443 living-donor transplants) have been performed in Japan. Neoplastic disease, including HCC, was reported to be the third-most common cause of liver transplantation, and the cumulative 1-, 3-, 5-, and 10-year survival rates of living-donor liver transplants for HCC were 85.0%, 76.2%, 70.9%, and 63.1%, respectively. However, molecular-targeted agents, including sorafenib and lenvatinib, have recently been developed. Furthermore, a significantly longer survival with atezolizumab, which is an immune checkpoint inhibitor, plus bevacizumab was observed compared with sorafenib for unresectable HCC patients. Herein, we review the current status of hepatic resection and liver transplantation for HCC in Japan and discuss the role of hepatic resection in the era of molecular-targeted agents and immune checkpoint inhibitors, as well as the need for a definition of borderline resectable-HCC.

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Survival impact of distal pancreatectomy with en bloc celiac axis resection combined with neoadjuvant chemotherapy for borderline resectable or locally advanced pancreatic body carcinoma

Cited by 10 publications

References 37 publications

Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer—A Korean Nationwide Investigation

Hepatic Resection for Hepatocellular Carcinoma in the Era of Molecular-targeted Agents and Immune Checkpoint Inhibitors in Japan

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