Surgical strategy for borderline resectable pancreatic body cancer.

Abstract

271 Background: The indications for distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) in pancreatic carcinoma remain controversial. Moreover, the incidence of delayed gastric emptying (DGE) is high in patients undergoing distal pancreatectomy with DP-CAR. Methods: Fifty-two consecutive patients with pancreatic cancer who underwent distal pancreatectomy, including 36 standard distal pancreatectomies (standard DP) and 16 DP-CAR were reviewed. To determine the incidence of DGE, 37 consecutive patients who underwent DP-CAR were evaluated for the incidence of DGE, including 23 patients with left gastric artery (LGA)-resecting DP-CAR (conventional DP-CAR) and compared it with 14 patients who underwent distal pancreatectomy with preservation of the LGA (modified DP-CAR). Results: The estimated overall 1- and 2-year survival rates after standard DP / DP-CAR were 81/81% and 52/53%, and the median survival times were 32/25 months, respectively, with no significant difference comparing standard DP. There were no differences in the mortality rates and the incidence of each complication between the two groups except for delayed gastric emptying. In the conventional DP-CAR group, the LGA were involved in 20 patients (87.0%). The ISGPS grades were: no DGE = 43%, grade A = 26%, B = 13% and C = 17% in the conventional DP-CAR group, and no DGE = 93%, grade A = 7%, grade B/C = 0% in the modified DP-CAR group. The R0 rate was higher in the modified DP-CAR group (79%) compared to the conventional DP-CAR group (43%) (p=0.048). On multivariate analysis, resection of the LGA was an independent risk factor for increased incidence of DGE. Conclusions: DP-CAR was a feasible and safe procedure, similar to standard DP. Modified DP-CAR significantly reduced the incidence of DGE in comparison to conventional DP-CAR.