Feasibility and safety of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) combined with neoadjuvant therapy for borderline resectable ... View Full Text


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Article Info

DATE

2019-03-13

AUTHORS

Hideyuki Yoshitomi, Nozomu Sakai, Shingo Kagawa, Shigetsugu Takano, Atsuhiko Ueda, Atsushi Kato, Katsunori Furukawa, Tsukasa Takayashiki, Satoshi Kuboki, Masaru Miyzaki, Masayuki Ohtsuka

ABSTRACT

PurposePancreatic body/tail cancer commonly invades the hepatic artery or celiac artery, making surgical resection difficult. Distal pancreatectomy with celiac axis resection (DP-CAR) has recently been performed to achieve curative resection of these tumors. However, the safety and efficacy remain unclear. This study aimed to clarify the efficacy and safety of DP-CAR, mainly focusing on the combination with neoadjuvant therapy (NAT).MethodsWe retrospectively reviewed 31 consecutive patients with pancreatic ductal adenocarcinoma who underwent DP-CAR between 2010 and 2016. Data from 7 patients who underwent DP-CAR without NAT were used as a reference (upfront surgery, US).ResultsGemcitabine + S-1 (GS) (n = 17) and gemcitabine + albumin-bound paclitaxel (GnP) (n = 8) were frequently used as NAT. DP-CAR following NAT was performed safely with 1 death, resulting in a mortality rate of 3%. The median survival time (MST) in the NAT group was 38.6 months, while that in the US group was 15.6 months. The NAT group had a high R0 resection rate (74%), while only 1 of 7 cases in the US group achieved R0 resection. Within the NAT group, patients treated with GS showed favorable overall survival with 39.5 months of MST, while that of patients treated with GnP was 19.8 months.ConclusionThe combination of NAT and DP-CAR was feasible and safe for pancreatic body/tail cancer invading the celiac artery and/or hepatic artery. This strategy should be further assessed for the optimal regimen and duration of NAT in prospective studies. More... »

PAGES

451-458

References to SciGraph publications

  • 2011-09-21. Feasibility of a dual microcatheter-dual interlocking detachable coil technique in preoperative embolization in preparation for distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer in JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
  • 2007-04-07. Stomach-Preserving Distal Pancreatectomy with Combined Resection of the Celiac Artery: Radical Procedure for Locally Advanced Cancer of the Pancreatic Body in JOURNAL OF GASTROINTESTINAL SURGERY
  • 1997-08. Distal pancreatectomy withen bloc resection of the celiac artery for carcinoma of the body and tail of the pancreas in JOURNAL OF GASTROINTESTINAL CANCER
  • 2006-05-23. Phase II trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer in BRITISH JOURNAL OF CANCER
  • 2014-08-08. Preservation of the Left Gastric Artery on the Basis of Anatomical Features in Patients Undergoing Distal Pancreatectomy with Celiac Axis En-bloc Resection (DP-CAR) in WORLD JOURNAL OF SURGERY
  • 2018-03-12. Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study in ANNALS OF SURGICAL ONCOLOGY
  • 2012-03-08. Distal Pancreatectomy with En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Adenocarcinoma Following Neoadjuvant Therapy in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2016-08-05. Distal Pancreatectomy with en Bloc Celiac Axis Resection (Modified Appleby Procedure) for Locally Advanced Pancreatic Body Cancer: A Single-Center Review of 80 Consecutive Patients in ANNALS OF SURGICAL ONCOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00423-019-01775-0

    DOI

    http://dx.doi.org/10.1007/s00423-019-01775-0

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1112731583

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30868241


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    28 schema:description PurposePancreatic body/tail cancer commonly invades the hepatic artery or celiac artery, making surgical resection difficult. Distal pancreatectomy with celiac axis resection (DP-CAR) has recently been performed to achieve curative resection of these tumors. However, the safety and efficacy remain unclear. This study aimed to clarify the efficacy and safety of DP-CAR, mainly focusing on the combination with neoadjuvant therapy (NAT).MethodsWe retrospectively reviewed 31 consecutive patients with pancreatic ductal adenocarcinoma who underwent DP-CAR between 2010 and 2016. Data from 7 patients who underwent DP-CAR without NAT were used as a reference (upfront surgery, US).ResultsGemcitabine + S-1 (GS) (n = 17) and gemcitabine + albumin-bound paclitaxel (GnP) (n = 8) were frequently used as NAT. DP-CAR following NAT was performed safely with 1 death, resulting in a mortality rate of 3%. The median survival time (MST) in the NAT group was 38.6 months, while that in the US group was 15.6 months. The NAT group had a high R0 resection rate (74%), while only 1 of 7 cases in the US group achieved R0 resection. Within the NAT group, patients treated with GS showed favorable overall survival with 39.5 months of MST, while that of patients treated with GnP was 19.8 months.ConclusionThe combination of NAT and DP-CAR was feasible and safe for pancreatic body/tail cancer invading the celiac artery and/or hepatic artery. This strategy should be further assessed for the optimal regimen and duration of NAT in prospective studies.
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    35 GNP
    36 GS
    37 MethodsWe
    38 NAT group
    39 R0 resection
    40 R0 resection rate
    41 ResultsGemcitabine
    42 US group
    43 adenocarcinoma
    44 albumin-bound paclitaxel
    45 artery
    46 body/tail cancer
    47 borderline
    48 cancer
    49 cases
    50 celiac artery
    51 celiac axis resection
    52 combination
    53 consecutive patients
    54 curative resection
    55 data
    56 death
    57 distal pancreatectomy
    58 ductal adenocarcinoma
    59 duration
    60 efficacy
    61 en bloc celiac axis resection
    62 favorable overall survival
    63 feasibility
    64 gemcitabine
    65 group
    66 hepatic artery
    67 higher R0 resection rate
    68 median survival time
    69 months
    70 mortality rate
    71 neoadjuvant therapy
    72 optimal regimen
    73 overall survival
    74 paclitaxel
    75 pancreatectomy
    76 pancreatic body/tail cancer
    77 pancreatic ductal adenocarcinoma
    78 patients
    79 prospective study
    80 rate
    81 reference
    82 regimen
    83 resection
    84 resection rate
    85 safety
    86 strategies
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    89 survival
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    91 tail cancer
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    95 schema:name Feasibility and safety of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) combined with neoadjuvant therapy for borderline resectable and unresectable pancreatic body/tail cancer
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