TY - JOUR
T1 - Is distal pancreatectomy with en-bloc celiac axis resection effective for patients with locally advanced pancreatic ductal adenocarcinoma? -Multicenter surgical group study
AU - Yamamoto, Tomohisa
AU - Satoi, Sohei
AU - Kawai, Manabu
AU - Motoi, Fuyuhiko
AU - Sho, Masayuki
AU - Uemura, Ken ichiro
AU - Matsumoto, Ippei
AU - Honda, Goro
AU - Okada, Ken ichi
AU - Akahori, Takahiro
AU - Toyama, Hirochika
AU - Kurata, Masanao
AU - Yanagimoto, Hiroaki
AU - Yamaue, Hiroki
AU - Unno, Michiaki
AU - Kon, Masanori
AU - Murakami, Yoshiaki
N1 - Publisher Copyright:
© 2017 IAP and EPC
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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.
KW - DP-CAR
KW - Locally advanced PDAC
KW - Overall survival
KW - Pancreatic ductal adenocarcinoma
KW - Postoperative morbidity
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UR - http://www.scopus.com/inward/citedby.url?scp=85034215206&partnerID=8YFLogxK
U2 - 10.1016/j.pan.2017.11.005
DO - 10.1016/j.pan.2017.11.005
M3 - Article
C2 - 29153701
AN - SCOPUS:85034215206
VL - 18
SP - 106
EP - 113
JO - Pancreatology
JF - Pancreatology
SN - 1424-3903
IS - 1
ER -
