BACKGROUND: Celiac trunk encasement by adenocarcinoma of the pancreatic body is generally regarded as a contraindication for surgical resection. Recent studies have suggested that a subset of stage III patients will succumb to their disease in the absence of distant metastases. We hypothesized that patients with stage III tumors invading the celiac trunk, who are free of distant disease following neoadjuvant therapy, may derive prolonged survival benefit from aggressive surgical resection. METHODS: We performed a retrospective review of distal pancreatectomies with en bloc celiac axis resection for pancreatic adenocarcinoma. RESULTS: Eleven patients underwent a distal pancreatectomy with en bloc celiac axis resection after completing neoadjuvant chemoradiation therapy. Median operative time was 8 h, 14 min, and median estimated blood loss was 700 ml. Median length of stay was 9 days. Five patients (45%) had postoperative complications; three were Clavien grade I. Four patients (35%) had pancreatic leaks; two were ISGPF grade B, and two were grade A. There were two 90-day perioperative deaths. Ten patients had R0 resections (91%). After a median follow-up of 41 weeks, six patients recurred. Four of the five patients with SMAD4 loss recurred, and two of the five patients with intact SMAD4 recurred. Median disease-free and overall survival were 21 weeks and 26 months, respectively. CONCLUSIONS: Resection of pancreatic body adenocarcinoma with celiac axis resection is technically feasible with acceptable perioperative morbidity and mortality.
BACKGROUND: Celiac trunk encasement by adenocarcinoma of the pancreatic body is generally regarded as a contraindication for surgical resection. Recent studies have suggested that a subset of stage III patients will succumb to their disease in the absence of distant metastases. We hypothesized that patients with stage III tumors invading the celiac trunk, who are free of distant disease following neoadjuvant therapy, may derive prolonged survival benefit from aggressive surgical resection. METHODS: We performed a retrospective review of distal pancreatectomies with en bloc celiac axis resection for pancreatic adenocarcinoma. RESULTS: Eleven patients underwent a distal pancreatectomy with en bloc celiac axis resection after completing neoadjuvant chemoradiation therapy. Median operative time was 8 h, 14 min, and median estimated blood loss was 700 ml. Median length of stay was 9 days. Five patients (45%) had postoperative complications; three were Clavien grade I. Four patients (35%) had pancreatic leaks; two were ISGPF grade B, and two were grade A. There were two 90-day perioperative deaths. Ten patients had R0 resections (91%). After a median follow-up of 41 weeks, six patients recurred. Four of the five patients with SMAD4 loss recurred, and two of the five patients with intact SMAD4 recurred. Median disease-free and overall survival were 21 weeks and 26 months, respectively. CONCLUSIONS: Resection of pancreatic body adenocarcinoma with celiac axis resection is technically feasible with acceptable perioperative morbidity and mortality.
Authors: Amanda Blackford; Oscar K Serrano; Christopher L Wolfgang; Giovanni Parmigiani; Siân Jones; Xiaosong Zhang; D Williams Parsons; Jimmy Cheng-Ho Lin; Rebecca J Leary; James R Eshleman; Michael Goggins; Elizabeth M Jaffee; Christine A Iacobuzio-Donahue; Anirban Maitra; John L Cameron; Kelly Olino; Richard Schulick; Jordan Winter; Joseph M Herman; Daniel Laheru; Alison P Klein; Bert Vogelstein; Kenneth W Kinzler; Victor E Velculescu; Ralph H Hruban Journal: Clin Cancer Res Date: 2009-07-07 Impact factor: 12.531
Authors: Horacio J Asbun; Jony Van Hilst; Levan Tsamalaidze; Yoshikuni Kawaguchi; Dominic Sanford; Lucio Pereira; Marc G Besselink; John A Stauffer Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584
Authors: Lee M Ocuin; Jennifer L Miller-Ocuin; Stephanie M Novak; David L Bartlett; J Wallis Marsh; Allan Tsung; Kenneth K Lee; Melissa E Hogg; Herbert J Zeh; Amer H Zureikat Journal: HPB (Oxford) Date: 2016-07-08 Impact factor: 3.647