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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2016

01-12-2016 | Pancreatic Tumors

Distal Pancreatectomy with en Bloc Celiac Axis Resection (Modified Appleby Procedure) for Locally Advanced Pancreatic Body Cancer: A Single-Center Review of 80 Consecutive Patients

Authors: Toru Nakamura, MD, PhD, Satoshi Hirano, MD, PhD, Takehiro Noji, MD, PhD, Toshimichi Asano, MD, PhD, Keisuke Okamura, MD, PhD, Takahiro Tsuchikawa, MD, PhD, Soichi Murakami, MD, PhD, Yo Kurashima, MD, PhD, Yuma Ebihara, MD, PhD, Yoshitsugu Nakanishi, MD, PhD, Kimitaka Tanaka, MD, PhD, Toshiaki Shichinohe, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 5/2016

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Abstract

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.
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Metadata
Title
Distal Pancreatectomy with en Bloc Celiac Axis Resection (Modified Appleby Procedure) for Locally Advanced Pancreatic Body Cancer: A Single-Center Review of 80 Consecutive Patients
Authors
Toru Nakamura, MD, PhD
Satoshi Hirano, MD, PhD
Takehiro Noji, MD, PhD
Toshimichi Asano, MD, PhD
Keisuke Okamura, MD, PhD
Takahiro Tsuchikawa, MD, PhD
Soichi Murakami, MD, PhD
Yo Kurashima, MD, PhD
Yuma Ebihara, MD, PhD
Yoshitsugu Nakanishi, MD, PhD
Kimitaka Tanaka, MD, PhD
Toshiaki Shichinohe, MD, PhD
Publication date
01-12-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue Special Issue 5/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5493-8

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