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Pancreatology. 2018 Jan;18(1):106-113. doi: 10.1016/j.pan.2017.11.005. Epub 2017 Nov 14.

Is distal pancreatectomy with en-bloc celiac axis resection effective for patients with locally advanced pancreatic ductal adenocarcinoma? -Multicenter surgical group study.

Author information

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.

KEYWORDS:

DP-CAR; Locally advanced PDAC; Overall survival; Pancreatic ductal adenocarcinoma; Postoperative morbidity

PMID:
29153701
DOI:
10.1016/j.pan.2017.11.005
[Indexed for MEDLINE]

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