TY - JOUR
T1 - Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study
AU - the E-AHPBA DP-CAR study group
AU - Klompmaker, Sjors
AU - van Hilst, Jony
AU - Gerritsen, Sarah L.
AU - Adham, Mustapha
AU - Teresa Albiol Quer, M.
AU - Bassi, Claudio
AU - Berrevoet, Frederik
AU - Boggi, Ugo
AU - Busch, Olivier R.
AU - Cesaretti, Manuela
AU - Dalla Valle, Raffaele
AU - Darnis, Benjamin
AU - de Pastena, Matteo
AU - del Chiaro, Marco
AU - Grützmann, Robert
AU - Diener, Markus K.
AU - Dumitrascu, Traian
AU - Friess, Helmut
AU - Ivanecz, Arpad
AU - Karayiannakis, Anastasios
AU - Fusai, Giuseppe K.
AU - Labori, Knut J.
AU - Lombardo, Carlo
AU - López-Ben, Santiago
AU - Mabrut, Jean-Yves
AU - Niesen, Willem
AU - Pardo, Fernando
AU - Perinel, Julie
AU - Popescu, Irinel
AU - Roeyen, Geert
AU - Sauvanet, Alain
AU - Prasad, Raj
AU - Sturesson, Christian
AU - Lesurtel, Mickael
AU - Kleeff, Jorg
AU - Salvia, Roberto
AU - Besselink, Marc G.
AU - Lykoudis, Panagis
AU - Hackert, Thilo H.
AU - Ateeb, Zeeshan
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85043467525&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29532342
U2 - https://doi.org/10.1245/s10434-018-6391-z
DO - https://doi.org/10.1245/s10434-018-6391-z
M3 - Article
C2 - 29532342
SN - 1068-9265
VL - 25
SP - 1440
EP - 1447
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 5
ER -