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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2018

Open Access 01-05-2018 | Pancreatic Tumors

Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study

Authors: Sjors Klompmaker, MD, Jony van Hilst, MD, Msc, Sarah L. Gerritsen, BSc, Mustapha Adham, MD, M. Teresa Albiol Quer, MD, Claudio Bassi, MD, Frederik Berrevoet, MD, Ugo Boggi, MD, Olivier R. Busch, MD, PhD, Manuela Cesaretti, MD, Raffaele Dalla Valle, MD, Benjamin Darnis, MD, Matteo De Pastena, MD, Marco Del Chiaro, MD, Robert Grützmann, MD, Markus K. Diener, MD, Traian Dumitrascu, MD, Helmut Friess, MD, Arpad Ivanecz, MD, Anastasios Karayiannakis, MD, Giuseppe K. Fusai, MD, Knut J. Labori, MD, PhD, Carlo Lombardo, MD, Santiago López-Ben, MD, Jean-Yves Mabrut, MD, Willem Niesen, MD, Fernando Pardo, MD, Julie Perinel, MD, Irinel Popescu, MD, Geert Roeyen, MD, Alain Sauvanet, MD, Raj Prasad, MD, Christian Sturesson, MD, Mickael Lesurtel, MD, PhD, Jorg Kleeff, MD, Roberto Salvia, MD, Marc G. Besselink, MD, Msc, PhD, the E-AHPBA DP-CAR study group

Published in: Annals of Surgical Oncology | Issue 5/2018

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Abstract

Background

Western multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE).

Methods

Retrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C).

Results

We included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10–37). We observed no impact of PHAE on ischemic complications.

Conclusions

DP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes.
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Literature
1.
2.
3.
4.
Appleby LH. The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer. 1953;6(4):704–7.CrossRefPubMed
5.
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(30):885–9.
6.
7.
Tempero MA, Malafa MP, Behrman SW, et al. Pancreatic adenocarcinoma, version 2.2014. J Natl Compr Cancer Netw. 2014;12:1083–93.CrossRef
8.
9.
10.
11.
12.
13.
14.
15.
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(35):1447–9.PubMed
16.
17.
18.
19.
20.
21.
22.
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, editors. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010, p. 241–9. https://​doi.​org/​10.​1007/​978-1-4614-2080-4.
23.
24.
25.
26.
27.
28.
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;261035.
29.
30.
31.
Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;6736(16):1-14. https://​doi.​org/​10.​1016/​s0140-6736(16)32409-6.
32.
33.
34.
35.
36.
Amin MB, Edge S, Greene F, Byrd DR, Robert K. Brookland, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Milburn Jessup J, Brierley JD, Gaspar LE, Richard L, Schi LRM. AJCC cancer staging manual. 8th ed. New York: Springer; 2017CrossRef
Metadata
Title
Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study
Authors
Sjors Klompmaker, MD
Jony van Hilst, MD, Msc
Sarah L. Gerritsen, BSc
Mustapha Adham, MD
M. Teresa Albiol Quer, MD
Claudio Bassi, MD
Frederik Berrevoet, MD
Ugo Boggi, MD
Olivier R. Busch, MD, PhD
Manuela Cesaretti, MD
Raffaele Dalla Valle, MD
Benjamin Darnis, MD
Matteo De Pastena, MD
Marco Del Chiaro, MD
Robert Grützmann, MD
Markus K. Diener, MD
Traian Dumitrascu, MD
Helmut Friess, MD
Arpad Ivanecz, MD
Anastasios Karayiannakis, MD
Giuseppe K. Fusai, MD
Knut J. Labori, MD, PhD
Carlo Lombardo, MD
Santiago López-Ben, MD
Jean-Yves Mabrut, MD
Willem Niesen, MD
Fernando Pardo, MD
Julie Perinel, MD
Irinel Popescu, MD
Geert Roeyen, MD
Alain Sauvanet, MD
Raj Prasad, MD
Christian Sturesson, MD
Mickael Lesurtel, MD, PhD
Jorg Kleeff, MD
Roberto Salvia, MD
Marc G. Besselink, MD, Msc, PhD
the E-AHPBA DP-CAR study group
Publication date
01-05-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6391-z

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