Tomohisa Yamamoto1, Sohei Satoi2, Manabu Kawai3, Fuyuhiko Motoi4, Masayuki Sho5, Ken-Ichiro Uemura6, Ippei Matsumoto7, Goro Honda8, Ken-Ichi Okada3, Takahiro Akahori5, Hirochika Toyama9, Masanao Kurata10, Hiroaki Yanagimoto1, Hiroki Yamaue3, Michiaki Unno4, Masanori Kon1, Yoshiaki Murakami6. 1. Department of Surgery, Kansai Medical University, Japan. 2. Department of Surgery, Kansai Medical University, Japan. Electronic address: satoi@hirakata.kmu.ac.jp. 3. Second Department of Surgery, Wakayama Medical University, Japan. 4. Department of Surgery, Tohoku University Graduate School of Medicine, Japan. 5. Department of Surgery, Nara Medical University, Japan. 6. Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Japan. 7. Department of Surgery, Kindai University Faculty of Medicine, Japan. 8. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan. 9. Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Japan. 10. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Japan.
Abstract
OBJECTIVES: We retrospectively investigated the operative outcomes of patients who underwent distal pancreatectomy (DP) for invasive pancreatic ductal adenocarcinoma (PDAC) located at the body and tail. METHODS: Data from 395 patients with PDAC who underwent DP with margin-negative resection (R0 or R1) were collected from seven high-volume centers in Japan from 2001 to 2012. Among them, 72 patients underwent DP with en-bloc celiac axis resection (DP-CAR). The remaining 323 patients underwent conventional DP with splenectomy (DP-S). To determine the efficacy of DP-CAR, clinicopathological data were compared between the DP-CAR and the DP-S groups. RESULTS: The DP-S group consisted mainly of patients with resectable disease (93%), and conversely, all patients in the DP-CAR group had borderline resectable or unresectable disease. The overall morbidity was significantly higher in the DP-CAR group than in the DP-S group (63% vs 47%, respectively; P = 0.017). The median survival time (MST) of the DP-CAR group was significantly shorter than that of the DP-S group (17.5 vs 28.6 months, respectively; P = 0.004). However, the MST of patients in the DP-CAR group (n = 61, 85%) who received adjuvant therapy was significantly longer than that of patients in the DP-S group (n = 65, 20%) who underwent R1 resection (21.9 vs 16.7 months, respectively; P = 0.024). CONCLUSION: DP-CAR followed by adjuvant chemotherapy provided an acceptable overall survival rate in patients with highly advanced PDAC, but should be performed with great caution because of high morbidity. Patients with a high risk of positive surgical margins with DP-S may be candidates for DP-CAR.
OBJECTIVES: We retrospectively investigated the operative outcomes of patients who underwent distal pancreatectomy (DP) for invasive pancreatic ductal adenocarcinoma (PDAC) located at the body and tail. METHODS: Data from 395 patients with PDAC who underwent DP with margin-negative resection (R0 or R1) were collected from seven high-volume centers in Japan from 2001 to 2012. Among them, 72 patients underwent DP with en-bloc celiac axis resection (DP-CAR). The remaining 323 patients underwent conventional DP with splenectomy (DP-S). To determine the efficacy of DP-CAR, clinicopathological data were compared between the DP-CAR and the DP-S groups. RESULTS: The DP-S group consisted mainly of patients with resectable disease (93%), and conversely, all patients in the DP-CAR group had borderline resectable or unresectable disease. The overall morbidity was significantly higher in the DP-CAR group than in the DP-S group (63% vs 47%, respectively; P = 0.017). The median survival time (MST) of the DP-CAR group was significantly shorter than that of the DP-S group (17.5 vs 28.6 months, respectively; P = 0.004). However, the MST of patients in the DP-CAR group (n = 61, 85%) who received adjuvant therapy was significantly longer than that of patients in the DP-S group (n = 65, 20%) who underwent R1 resection (21.9 vs 16.7 months, respectively; P = 0.024). CONCLUSION:DP-CAR followed by adjuvant chemotherapy provided an acceptable overall survival rate in patients with highly advanced PDAC, but should be performed with great caution because of high morbidity. Patients with a high risk of positive surgical margins with DP-S may be candidates for DP-CAR.
Authors: Yeon Su Kim; Ji Su Kim; Sung Hyun Kim; Ho Kyoung Hwang; Woo Jung Lee; Chang Moo Kang Journal: Ann Hepatobiliary Pancreat Surg Date: 2022-02-28