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

Klompmaker, Sjors; van Hilst, Jony; Gerritsen, Sarah L.; Adham, Mustapha; Teresa Albiol Quer, M.; Bassi, Claudio; Berrevoet, Frederik; Boggi, Ugo; Busch, Olivier R. and Cesaretti, Manuela, et al. (2018) In Annals of Surgical Oncology p.1-8
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%... (More)

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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@article{82db74f4-8ae5-4e76-b1b3-1d15ae2efc6b,
  abstract     = {<p>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.</p>},
  author       = {Klompmaker, Sjors and van Hilst, Jony and Gerritsen, Sarah L. and Adham, Mustapha and Teresa Albiol Quer, M. and Bassi, Claudio and Berrevoet, Frederik and Boggi, Ugo and Busch, Olivier R. and Cesaretti, Manuela and Dalla Valle, Raffaele and Darnis, Benjamin and de Pastena, Matteo and Del Chiaro, Marco and Grützmann, Robert and Diener, Markus K. and Dumitrascu, Traian and Friess, Helmut and Ivanecz, Arpad and Karayiannakis, Anastasios and Fusai, Giuseppe K. and Labori, Knut J. and Lombardo, Carlo and López-Ben, Santiago and Mabrut, Jean Yves and Niesen, Willem and Pardo, Fernando and Perinel, Julie and Popescu, Irinel and Roeyen, Geert and Sauvanet, Alain and Prasad, Raj and Sturesson, Christian and Lesurtel, Mickael and Kleeff, Jorg and Salvia, Roberto and Besselink, Marc G. and Lykoudis, Panagis and Hackert, Thilo H. and Ateeb, Zeeshan and , },
  issn         = {1068-9265},
  language     = {eng},
  month        = {03},
  pages        = {1--8},
  publisher    = {Springer},
  series       = {Annals of Surgical Oncology},
  title        = {Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer : A Pan-European Retrospective Cohort Study},
  url          = {http://dx.doi.org/10.1245/s10434-018-6391-z},
  year         = {2018},
}