Multivisceral Resection for Pancreatic Ductal Adenocarcinoma of the Body and Tail: Is it Worth? A Multicentre Retrospective Analysis from Western European Countries

Abstract

Background: Ductal left-sided pancreatic adenocarcinoma is often associated with poor prognosis due to the delayed diagnosis, with a lower resectability rate compared to pancreatic head tumours. Multivisceral resections (MVR) associated with distal pancreatectomy could be proposed for patients presenting with locally advanced disease. Methods: We retrospectively analyzed a multicentric cohort of patients operated for ductal left-sided locally-advanced pancreatic adenocarcinoma over 11 years (from 2009 to 2020). Thirteen European high-volume HPB Units participated to this study. We analyzed patients who underwent distal pancreatectomy (DP) associated with MVR and compared them to standard DP. Results: Among 258 patients treated curatively for locally advanced pancreatic adenocarcinoma of the body and tail, 28 patients successfully underwent MVR. A longer operative time was observed in MVR group (295 min +/- 74 vs. 250min +/- 96, p= 0,248). Post-operative complication rate was comparable between the two groups (46,4 % in MVR group vs. 62,2% in control group, p= 0,108). The incidence of positive margin (R1) was similar between the two groups (8/28, 28,6% vs. 61/230, 26,6%; p=0,827). After a median of follow-up of 25 (9-111) months, overall survival was comparable between the two groups (14/28, 50% vs. 116/230, 50%; p= 0,519). Conclusions: Multivisceral resection in locally-advanced left-sided pancreatic adenocarcinoma is safe and feasible and should be considered in selected cases as it seems provide acceptable surgical and oncological outcomes.