BACKGROUND: With improved neoadjuvant regimens, more aggressive surgical resections may be warranted for patients with locally advanced pancreatic cancer (LAPC) with focal encasement of the celiac axis (CA) and proximal common hepatic artery (HA). We sought to investigate the clinicopathological features and outcomes of the modified Appleby procedure (DP-CAR) in light of improved neoadjuvant therapies. METHODS: A prospectively maintained database of all pancreatectomies performed at Johns Hopkins Hospital, Baltimore, MD, USA, was reviewed to identify all patients who underwent DP-CAR for pancreatic ductal adenocarcinoma (PDAC) between 2004 and 2016. A 3:1 match for patients undergoing distal pancreatectomy (DP) versus DP-CAR was performed on the basis of their clinicopathological features. RESULTS: Seventeen patients who underwent DP-CAR were matched to 51 patients who underwent DP for resection of PDAC. Prior to DP-CAR, 15 (88.2 %) patients received neoadjuvant therapy, and the most frequently used regimen was FOLFIRINOX (80.0 %). DP-CAR was associated with longer operative time (404 vs. 309 min; p = 0.003) and elevated postoperative liver transaminases compared with DP. No difference was observed in estimated blood loss and length of hospitalization. R0 resection was achieved in 82.4 % of DP-CAR patients versus 92.2 % of DP patients (p = 0.355). No difference was observed in postoperative outcomes, including overall complications, pancreatic fistula, readmission, and mortality. Median survival for DP-CAR was 20 versus 19 months in the DP group (p = 0.757). CONCLUSION: In light of improved neoadjuvant therapeutic regimens, the modified Appleby procedure is a feasible and safe treatment option for patients with LAPC involving the CA, with morbidity and mortality similar to patients undergoing classic DP.
BACKGROUND: With improved neoadjuvant regimens, more aggressive surgical resections may be warranted for patients with locally advanced pancreatic cancer (LAPC) with focal encasement of the celiac axis (CA) and proximal common hepatic artery (HA). We sought to investigate the clinicopathological features and outcomes of the modified Appleby procedure (DP-CAR) in light of improved neoadjuvant therapies. METHODS: A prospectively maintained database of all pancreatectomies performed at Johns Hopkins Hospital, Baltimore, MD, USA, was reviewed to identify all patients who underwent DP-CAR for pancreatic ductal adenocarcinoma (PDAC) between 2004 and 2016. A 3:1 match for patients undergoing distal pancreatectomy (DP) versus DP-CAR was performed on the basis of their clinicopathological features. RESULTS: Seventeen patients who underwent DP-CAR were matched to 51 patients who underwent DP for resection of PDAC. Prior to DP-CAR, 15 (88.2 %) patients received neoadjuvant therapy, and the most frequently used regimen was FOLFIRINOX (80.0 %). DP-CAR was associated with longer operative time (404 vs. 309 min; p = 0.003) and elevated postoperative liver transaminases compared with DP. No difference was observed in estimated blood loss and length of hospitalization. R0 resection was achieved in 82.4 % of DP-CARpatients versus 92.2 % of DPpatients (p = 0.355). No difference was observed in postoperative outcomes, including overall complications, pancreatic fistula, readmission, and mortality. Median survival for DP-CAR was 20 versus 19 months in the DP group (p = 0.757). CONCLUSION: In light of improved neoadjuvant therapeutic regimens, the modified Appleby procedure is a feasible and safe treatment option for patients with LAPC involving the CA, with morbidity and mortality similar to patients undergoing classic DP.
Authors: Georgios Gemenetzis; Vincent P Groot; Alex B Blair; Daniel A Laheru; Lei Zheng; Amol K Narang; Elliot K Fishman; Ralph H Hruban; Jun Yu; Richard A Burkhart; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: Ann Surg Date: 2019-08 Impact factor: 12.969
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: Ryan K Schmocker; Michael J Wright; Ding Ding; Michael J Beckman; Ammar A Javed; John L Cameron; Kelly J Lafaro; William R Burns; Matthew J Weiss; Jin He; Christopher L Wolfgang; Richard A Burkhart Journal: Ann Surg Oncol Date: 2020-10-13 Impact factor: 4.339