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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2016

01-10-2016 | Pancreatic Tumors

Modified Appleby Procedure for Pancreatic Adenocarcinoma: Does Improved Neoadjuvant Therapy Warrant Such an Aggressive Approach?

Authors: Niek A. Peters, BSc, Ammar A. Javed, MD, John L. Cameron, MD, FACS, Martin A. Makary, MD, MPH, FACS, Kenzo Hirose, MD, FACS, Timothy M. Pawlik, MD, PhD, MPH, FACS, Jin He, MD, PhD, FACS, Christopher L. Wolfgang, MD, PhD, FACS, Matthew J. Weiss, MD, FACS

Published in: Annals of Surgical Oncology | Issue 11/2016

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Abstract

Background

With improved neoadjuvant regimens, more aggressive surgical resections may be warranted for patients with locally advanced pancreatic cancer (LAPC) with focal encasement of the celiac axis (CA) and proximal common hepatic artery (HA). We sought to investigate the clinicopathological features and outcomes of the modified Appleby procedure (DP-CAR) in light of improved neoadjuvant therapies.

Methods

A prospectively maintained database of all pancreatectomies performed at Johns Hopkins Hospital, Baltimore, MD, USA, was reviewed to identify all patients who underwent DP-CAR for pancreatic ductal adenocarcinoma (PDAC) between 2004 and 2016. A 3:1 match for patients undergoing distal pancreatectomy (DP) versus DP-CAR was performed on the basis of their clinicopathological features.

Results

Seventeen patients who underwent DP-CAR were matched to 51 patients who underwent DP for resection of PDAC. Prior to DP-CAR, 15 (88.2 %) patients received neoadjuvant therapy, and the most frequently used regimen was FOLFIRINOX (80.0 %). DP-CAR was associated with longer operative time (404 vs. 309 min; p = 0.003) and elevated postoperative liver transaminases compared with DP. No difference was observed in estimated blood loss and length of hospitalization. R0 resection was achieved in 82.4 % of DP-CAR patients versus 92.2 % of DP patients (p = 0.355). No difference was observed in postoperative outcomes, including overall complications, pancreatic fistula, readmission, and mortality. Median survival for DP-CAR was 20 versus 19 months in the DP group (p = 0.757).

Conclusion

In light of improved neoadjuvant therapeutic regimens, the modified Appleby procedure is a feasible and safe treatment option for patients with LAPC involving the CA, with morbidity and mortality similar to patients undergoing classic DP.
Appendix
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Metadata
Title
Modified Appleby Procedure for Pancreatic Adenocarcinoma: Does Improved Neoadjuvant Therapy Warrant Such an Aggressive Approach?
Authors
Niek A. Peters, BSc
Ammar A. Javed, MD
John L. Cameron, MD, FACS
Martin A. Makary, MD, MPH, FACS
Kenzo Hirose, MD, FACS
Timothy M. Pawlik, MD, PhD, MPH, FACS
Jin He, MD, PhD, FACS
Christopher L. Wolfgang, MD, PhD, FACS
Matthew J. Weiss, MD, FACS
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5303-3

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