M Cesaretti1, M Abdel-Rehim2, L Barbier1, S Dokmak1, P Hammel3, A Sauvanet4. 1. Service de chirurgie hépatobiliaire et pancréatique, pôle des maladies de l'appareil digestif, hôpital Beaujon, AP-HP, université Paris VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France. 2. Service de radiologie, hôpital Beaujon, AP-HP, université Paris 7, 92110 Clichy, France. 3. Service d'oncologie digestive, hôpital Beaujon, AP-HP, université Paris 7, 92110 Clichy, France. 4. Service de chirurgie hépatobiliaire et pancréatique, pôle des maladies de l'appareil digestif, hôpital Beaujon, AP-HP, université Paris VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France. Electronic address: alain.sauvanet@aphp.fr.
Abstract
BACKGROUND: In distal pancreatic ductal adenocarcinoma (PDAC), distal pancreatectomy with en bloc splenectomy and celiac axis resection (DP-CAR) can allow curative resection in case of tumor extension to celiac axis. METHODS: From 2008 to 2013, of 102 patients with localized distal PDAC, 7 patients with celiac axis involvement were planned to undergo DP-CAR with curative intent. All patients received neoadjuvant treatment followed by preoperative coil embolization to enlarge collateral arterial pathways, except if a replaced right hepatic artery arising from superior mesenteric artery was present and sufficient for the blood supply. We herein analyzed indications, technique and outcomes of DP-CAR. RESULTS: After neoadjuvant treatment and arterial embolization, two patients experienced tumor progression and were not operated while five underwent DP-CAR. No patient required arterial reconstruction. Postoperative mortality was nil, but morbidity was 100%, mainly represented by pancreatic fistula. Postoperatively, there was a complete pain relief but chronic diarrhea was observed in all patients. Resections were R0 in three patients. One operated patient was alive and disease free at 60 months whereas median overall survival of patients who underwent resection was 24 months. CONCLUSIONS: DP-CAR for borderline resectable/locally advanced distal PDAC is associated with high morbidity and mixed long-term functional results. Neoadjuvant treatment may prevent from unnecessary surgery for patients with progressive disease and may facilitate resection with acceptable long-term survival.
BACKGROUND: In distal pancreatic ductal adenocarcinoma (PDAC), distal pancreatectomy with en bloc splenectomy and celiac axis resection (DP-CAR) can allow curative resection in case of tumor extension to celiac axis. METHODS: From 2008 to 2013, of 102 patients with localized distal PDAC, 7 patients with celiac axis involvement were planned to undergo DP-CAR with curative intent. All patients received neoadjuvant treatment followed by preoperative coil embolization to enlarge collateral arterial pathways, except if a replaced right hepatic artery arising from superior mesenteric artery was present and sufficient for the blood supply. We herein analyzed indications, technique and outcomes of DP-CAR. RESULTS: After neoadjuvant treatment and arterial embolization, two patients experienced tumor progression and were not operated while five underwent DP-CAR. No patient required arterial reconstruction. Postoperative mortality was nil, but morbidity was 100%, mainly represented by pancreatic fistula. Postoperatively, there was a complete pain relief but chronic diarrhea was observed in all patients. Resections were R0 in three patients. One operated patient was alive and disease free at 60 months whereas median overall survival of patients who underwent resection was 24 months. CONCLUSIONS:DP-CAR for borderline resectable/locally advanced distal PDAC is associated with high morbidity and mixed long-term functional results. Neoadjuvant treatment may prevent from unnecessary surgery for patients with progressive disease and may facilitate resection with acceptable long-term survival.
Authors: Sjors Klompmaker; Jony van Hilst; Sarah L Gerritsen; Mustapha Adham; M Teresa Albiol Quer; Claudio Bassi; Frederik Berrevoet; Ugo Boggi; Olivier R Busch; Manuela Cesaretti; Raffaele Dalla Valle; Benjamin Darnis; Matteo De Pastena; Marco Del Chiaro; Robert Grützmann; Markus K Diener; Traian Dumitrascu; Helmut Friess; Arpad Ivanecz; Anastasios Karayiannakis; Giuseppe K Fusai; Knut J Labori; Carlo Lombardo; Santiago López-Ben; Jean-Yves Mabrut; Willem Niesen; Fernando Pardo; Julie Perinel; Irinel Popescu; Geert Roeyen; Alain Sauvanet; Raj Prasad; Christian Sturesson; Mickael Lesurtel; Jorg Kleeff; Roberto Salvia; Marc G Besselink Journal: Ann Surg Oncol Date: 2018-03-12 Impact factor: 5.344
Authors: Viacheslav Egorov; Pavel Kim; Alexander Kharazov; Soslan Dzigasov; Pavel Popov; Sofia Rykova; Pavel Zelter; Anna Demidova; Eugeny Kondratiev; Maxim Grigorievsky; Alexander Sorokin Journal: Cancers (Basel) Date: 2022-02-28 Impact factor: 6.639