Elsevier

Surgery

Volume 151, Issue 1, January 2012, Pages 61-69
Surgery

Original Communication
Is celiac axis resection justified for T4 pancreatic body cancer?

https://doi.org/10.1016/j.surg.2011.06.030Get rights and content

Background

The clinical impact of the distal pancreatectomy with en-bloc celiac axis resection for locally advanced pancreatic body cancer remains unclear.

Methods

We reviewed the records of 13 patients who underwent distal pancreatectomy-celiac axis resection between 1991 and 2009, 58 patients who underwent distal pancreatectomy for pancreatic body cancer involving major vessels, the extrapancreatic neural plexus or other organs (T4 according to the Japanese stage classification) between 1991 and 2009, and 24 patients with unresectable locally advanced pancreatic cancer without distant metastases (unresectable group) between 2001 and 2009. The clinicopathologic factors and overall survival among the 3 groups were compared.

Results

The distal pancreatectomy-celiac axis resection group was associated with a significantly higher incidence of morbidity (92% vs 60%, P = .03) and positive surgical margins (69% vs 26%, P = .003) than the distal pancreatectomy group; however, no survival difference was found between the 2 groups. No survivor has lived more than 3 years after operation in the distal pancreatectomy-celiac axis resection group. The distal pancreatectomy-celiac axis resection group had a significantly better prognosis than the unresectable group (median survival time, 20.8 vs 9.8 months; P = .01).

Conclusion

Aggressive resection for T4 pancreatic body cancer by distal pancreatectomy-celiac axis resection can be justified for otherwise unresectable tumors. The surgical indication should be evaluated carefully because of the higher incidence of morbidity and lower incidence of curability compared with distal pancreatectomy, as well as because there have been no long-term survivors so far.

Section snippets

Patients and methods

Between January 1991 and April 2009, 71 patients underwent DP with or without resection of CA for pancreatic body cancer involving major vessels, the extrapancreatic neural plexus, or other organs, which was classified as T4 cancer according to the 5th edition of the General Rules for the Study of Pancreatic Cancer issued by the Japan Pancreas Society (JPS 5th edition).19 Pancreatic body cancer refers to pancreatic cancer with the predominant location of the tumor in the pancreatic body. All 71

Patient background

Age, sex, serum level of CEA, and serum level of CA19-9 were comparable among the 3 groups (Table I).

Surgical procedures

The DP-CAR was associated with a longer operative time, greater blood loss, more blood transfusions, and portal vein resection. During the DP-CAR, 7 of 13 patients underwent combined total gastrectomy to prevent gastric ischemic complications.

Short-term outcomes

No patients undergoing the DP-CAR or DP died as a result of operation. The overall morbidity rate was significantly higher in the DP-CAR group than in the

Discussion

The present study disclosed the difference in surgical results between the DP-CAR and DP for treating T4 pancreatic body adenocarcinomas. There was no in-hospital mortality in either group, although the surgical morbidity was significantly higher in the DP-CAR group than in the DP group (92% vs 60%). The incidence of microscopically curative (R0) resection was significantly lower in the DP-CAR group than in the DP group (31% vs 74%, P = .003). No significant differences were observed in overall

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    Supported by a Grant-in-Aid for cancer research from the Ministry of Health Welfare and Labor of Japan.

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