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Open Access 01-03-2019 | Pancreatectomy | Hepatobiliary Tumors

Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis

Authors: Sjors Klompmaker, MD, Niek A. Peters, MD, Jony van Hilst, MD, Claudio Bassi, MD, Ugo Boggi, MD, PhD, Olivier R. Busch, MD, PhD, Willem Niesen, MD, Thomas M. Van Gulik, MD, PhD, Ammar A. Javed, MD, Jorg Kleeff, MD, FACS, Manabu Kawai, MD, PhD, Mickael Lesurtel, MD, PhD, Carlo Lombardo, MD, A. James Moser, MD, FACS, Ken-ichi Okada, MD, PhD, Irinel Popescu, MD, Raj Prasad, MD, Roberto Salvia, MD, Alain Sauvanet, MD, Christian Sturesson, MD, Matthew J. Weiss, MD, FACS, Herbert J. Zeh, MD, FACS, Amer H. Zureikat, MD, FACS, Hiroki Yamaue, MD, PhD, Christopher L. Wolfgang, MD, MS, PhD, Melissa E. Hogg, MD, FACS, Marc G. Besselink, MD, PhD, the E-AHPBA DP-CAR study group

Published in: Annals of Surgical Oncology | Issue 3/2019

Abstract

Background

Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes.

Methods

This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000–2016) and three very-high-volume international centers in the United States and Japan (model validation 2004–2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival.

Results

For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2–11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9–30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15–25 months).

Conclusions

When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.

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Kondo S, Katoh H, Shimizu T, et al. Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepatogastroenterology 2000; 47:1447–9.PubMed

Klompmaker S, De Rooij T, Korteweg JJ, et al. Systematic review of outcomes after distal pancreatectomy with coeliac axis resection for locally advanced pancreatic cancer. BJS 2016; 103:941–9. https://doi.org/10.1002/bjs.10148.CrossRef

Peters NA, Javed AA, Cameron JL, et al. Modified appleby procedure for pancreatic adenocarcinoma: Does improved neoadjuvant therapy warrant such an aggressive approach? Ann Surg Oncol 2016; 23:3757–64. https://doi.org/10.1245/s10434-016-5303-3.CrossRefPubMed

Ocuin LM, Miller-Ocuin JL, Novak SM, et al. Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: a single-institutional assessment of perioperative outcomes and survival. HPB 2016; 18:835–42. https://doi.org/10.1016/j.hpb.2016.05.003.CrossRefPubMedPubMedCentral

Nakamura T, Hirano S, Noji T, et al. 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. Ann Surg Oncol 2016; 23(Suppl 5):969–75. https://doi.org/10.1245/s10434-016-5493-8.CrossRefPubMed

Sugiura T, Okamura Y, Ito T, Yamamoto Y, Uesaka K. Surgical indications of distal pancreatectomy with celiac axis resection for pancreatic body/tail cancer. World J Surg 2016; 41:258–66. https://doi.org/10.1007/s00268-016-3670-3.CrossRef

Klompmaker S, van Hilst J, Gerritsen SL, et al. Outcomes after distal pancreatectomy with celiac axis resection for pancreatic cancer: a pan-European retrospective cohort study. Ann Surg Oncol 2018; 25:1440–7. https://doi.org/10.1245/s10434-018-6391-z.CrossRefPubMedPubMedCentral

Denecke T, Andreou A, Podrabsky P, et al. Distal pancreatectomy with en bloc resection of the celiac trunk for extended pancreatic tumor disease: an interdisciplinary approach. Cardiovasc Intervent Radiol 2011; 34:1058–64. https://doi.org/10.1007/s00270-010-9997-5.CrossRefPubMed

Baumgartner JM, Krasinskas A, Daouadi M, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic adenocarcinoma following neoadjuvant therapy. J Gastrointest Surg 2012; 16:1152–9. https://doi.org/10.1007/s11605-012-1839-0.CrossRefPubMed

10.

Klompmaker S, van Zoggel D, Watkins AAA, et al. Nationwide evaluation of patient selection for minimally invasive distal pancreatectomy using American College of Surgeons’ National Quality Improvement Program. Ann Surg 2017; 266:1055–61. https://doi.org/10.1097/SLA.0000000000001982.CrossRefPubMed

11.

Moons KGM, Kengne AP, Grobbee DE, et al. Risk prediction models: II. External validation, model updating, and impact assessment. Heart 2012; 98:691–8. https://doi.org/10.1136/heartjnl-2011-301247.

12.

Okada K, Kawai M, Tani M, et al. Preservation of the left gastric artery on the basis of anatomical features in patients undergoing distal pancreatectomy with celiac axis en bloc resection (DP-CAR). World J Surg 2014; 38:2980–5. https://doi.org/10.1007/s00268-014-2702-0.CrossRefPubMed

13.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147:573–7. https://doi.org/10.7326/0003-4819-147-8-200710160-00010.CrossRef

14.

Nimura Y, Hattory T, Miura K, Nakajima N, Hibi M. Our experience of resection of carcinoma of the body and tail of the pancreas by Appleby’s procedure. Operation 1976; 15:885–9.

15.

Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefPubMedPubMedCentral

16.

Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017; 161:584–91. https://doi.org/10.1016/j.surg.2016.11.014.CrossRefPubMed

17.

Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142:761–8. https://doi.org/10.1016/j.surg.2007.05.005.CrossRefPubMed

18.

Wente MN, Veit JA, Bassi C, Dervenis C. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142:20–5. https://doi.org/10.1016/j.surg.2007.02.001.CrossRefPubMed

19.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27:97–132; quiz 133–4; discussion 96. https://doi.org/10.1016/s0196-6553(99)70088-x.

20.

The Royal College of Pathologists. Standards and minimum datasets for reporting cancers minimum dataset for the histopathological reporting of pancreatic, ampulla of Vater and bile duct carcinoma. London: The Royal College of Pathologists; 2002.

21.

Janssen KJM, Moons KGM, Kalkman CJ, Grobbee DE, Vergouwe Y. Updating methods improved the performance of a clinical prediction model in new patients. J Clin Epidemiol 2008; 61:76–86. https://doi.org/10.1016/j.jclinepi.2007.04.018.CrossRefPubMed

22.

Ravaioli M, Pinna AD, Francioni G, et al. A partnership model between high- and low-volume hospitals to improve results in hepatobiliary pancreatic surgery. Ann Surg 2014; 260:871–7. https://doi.org/10.1097/sla.0000000000000975.CrossRefPubMed

23.

Compton C, Byrd D, Garcia-Aguilar J, Kurtzman S, Olawaiye A, Washington M. Exocrine and endocrine pancreas. In: Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A (eds) AJCC Cancer Staging Manual, 7th edn. Springer, New York, NY, 2010, pp 241–9. https://doi.org/10.1007/978-1-4614-2080-4.

24.

Austin PC, Steyerberg EW. Graphical assessment of internal and external calibration of logistic regression models by using loess smoothers. Stat Med 2014; 33:517–35. https://doi.org/10.1002/sim.5941.CrossRefPubMed

25.

van der Geest LGMGM, van Rijssen LBB, Molenaar IQQ, et al. Volume–outcome relationships in pancreatoduodenectomy for cancer. HPB 2016; 18:317–24. https://doi.org/10.1016/j.hpb.2016.01.515.

26.

Finks J, Osborne N, Birkmeyer JD. Trends in hospital volume and operative. N Engl J Med 2011; 364:2128–37. https://doi.org/10.1097/aln.0b013e31822efcdd.CrossRefPubMedPubMedCentral

27.

Fusai GK, Pereira S, Valente R, Ravikumar R, Lykoudis P. The arterial study network. Published 2015. Retrieved 10 September 2015 at https://www.thearterialstudy.net.

Title: Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis
Authors: Sjors Klompmaker, MD
Niek A. Peters, MD
Jony van Hilst, MD
Claudio Bassi, MD
Ugo Boggi, MD, PhD
Olivier R. Busch, MD, PhD
Willem Niesen, MD
Thomas M. Van Gulik, MD, PhD
Ammar A. Javed, MD
Jorg Kleeff, MD, FACS
Manabu Kawai, MD, PhD
Mickael Lesurtel, MD, PhD
Carlo Lombardo, MD
A. James Moser, MD, FACS
Ken-ichi Okada, MD, PhD
Irinel Popescu, MD
Raj Prasad, MD
Roberto Salvia, MD
Alain Sauvanet, MD
Christian Sturesson, MD
Matthew J. Weiss, MD, FACS
Herbert J. Zeh, MD, FACS
Amer H. Zureikat, MD, FACS
Hiroki Yamaue, MD, PhD
Christopher L. Wolfgang, MD, MS, PhD
Melissa E. Hogg, MD, FACS
Marc G. Besselink, MD, PhD
the E-AHPBA DP-CAR study group
Publication date: 01-03-2019
Publisher: Springer International Publishing
Keyword: Pancreatectomy
Published in: Annals of Surgical Oncology / Issue 3/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-07101-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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