Distal Pancreatectomy with Celiac Axis Resection for Carcinoma of the Body and Tail of the Pancreas

Abstract

We retrospectively investigated our experiences with distal pancreatectomy with celiac axis resection (DP-CAR) for locally advanced pancreatic cancer and compared the operative outcome and long-term survival between DP-CAR and standard distal pancreatectomy (DP). Although several authors reported that DP-CAR increases resectability rates, the long-term results of this operation are not clear, and there are few reports presenting a comparison of the short- and long-term results between DP-CAR and DP. From 1993 to 2010, 43 patients with invasive ductal carcinoma of the body or tail of the pancreas underwent a macroscopically curative resection (R0/1). Sixteen patients underwent DP-CAR and 27 patients underwent DP. No DP-CAR patients underwent any preoperative coil embolization of the common hepatic artery (CHA) to stimulate the development of collateral pathways from the superior mesenteric artery. The perioperative and histopathologic parameters and survival data were analyzed to compare the two operations. There was no difference in mean operative time, mean blood loss, postoperative mortality, and morbidity between DP-CAR and DP. The rates of morbidity and in-hospital mortality of DP-CAR were 56 and 6%, respectively. In DP-CAR, 15 patients did not require reconstruction of the hepatic artery and no hepatic infarctions were clinically encountered after surgery. The estimated overall 1- and 3-year survival rates in patients who underwent DP-CAR were 42.6 and 25.6%, respectively, and their survival time was significantly less than that of patients who underwent DP (median survival time: 9.7 vs. 30.9months, P=0.033). The R1 resection rates of these groups were 44% in DP-CAR and 22% in DP, respectively. DP-CAR is a safe and rational procedure for locally advanced pancreatic cancer without preoperative embolization of the CHA. Although the short-term results were equivalent to that for DP, DP-CAR did not improve the long-term survival because of the high rate of R1 resection at present.