BACKGROUND: Recently, distal pancreatectomy with en bloc celiac axis resection (DP-CAR) or modified Appleby procedure for locally advanced pancreatic body cancer is increasingly reported. However, actual long-term survival data are still unknown. METHODS: This study retrospectively reviewed 80 consecutive patients with pancreatic body cancer who underwent DP-CAR at a single institution. RESULTS: The study included 40 men and 40 women with a median age of 65 years (range, 44-85 years). A pancreatic fistula was the most common complication, occurring in 47 patients (57.5 %). Other complications with a high incidence were ischemic gastropathy (23 patients, 28.8 %) and delayed gastric emptying (20 patients, 25 %). According to the Clavien-Dindo classification, the major complications, defined as complications of grade 3 or higher, were observed in 33 patients (41.3 %), and the in-hospital mortality involved four patients (5 %). For all 80 patients, the 1-, 2-, and 5-year overall survivals (OSs) were respectively 81.1, 56.9, and 32.7 %, and the median survival time was 30.9 months. The actual 5-year survival for the 61 patients whose surgery was performed five or more years earlier was 27.9 % (17 of 61). The 1-, 2-, and 5-year OSs for the patients who underwent preoperative therapy (100, 90, and 78.8 %) were significantly better than for those who underwent upfront surgery (77.9, 51.5, and 26.7 %; P < 0.0001). CONCLUSIONS: The findings show DP-CAR to be a valid procedure for treating locally advanced pancreatic body cancer, which might contribute more to patients' survival when performed as part of multidisciplinary treatment.
BACKGROUND: Recently, distal pancreatectomy with en bloc celiac axis resection (DP-CAR) or modified Appleby procedure for locally advanced pancreatic body cancer is increasingly reported. However, actual long-term survival data are still unknown. METHODS: This study retrospectively reviewed 80 consecutive patients with pancreatic body cancer who underwent DP-CAR at a single institution. RESULTS: The study included 40 men and 40 women with a median age of 65 years (range, 44-85 years). A pancreatic fistula was the most common complication, occurring in 47 patients (57.5 %). Other complications with a high incidence were ischemic gastropathy (23 patients, 28.8 %) and delayed gastric emptying (20 patients, 25 %). According to the Clavien-Dindo classification, the major complications, defined as complications of grade 3 or higher, were observed in 33 patients (41.3 %), and the in-hospital mortality involved four patients (5 %). For all 80 patients, the 1-, 2-, and 5-year overall survivals (OSs) were respectively 81.1, 56.9, and 32.7 %, and the median survival time was 30.9 months. The actual 5-year survival for the 61 patients whose surgery was performed five or more years earlier was 27.9 % (17 of 61). The 1-, 2-, and 5-year OSs for the patients who underwent preoperative therapy (100, 90, and 78.8 %) were significantly better than for those who underwent upfront surgery (77.9, 51.5, and 26.7 %; P < 0.0001). CONCLUSIONS: The findings show DP-CAR to be a valid procedure for treating locally advanced pancreatic body cancer, which might contribute more to patients' survival when performed as part of multidisciplinary treatment.
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