Distal pancreatectomy with en bloc celiac axis resection for pancreatic cancer: a pooled analysis of 109 cases
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REVIEW ARTICLE
Distal pancreatectomy with en bloc celiac axis resection for pancreatic cancer: a pooled analysis of 109 cases Jianfa Lan1 · Yufeng Chen2 · Shijie Wang1 · Yanming Zhou1 Received: 3 February 2020 / Accepted: 29 May 2020 © Italian Society of Surgery (SIC) 2020
Abstract The aim of this study was to define the clinical outcome and prognostic determinants of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for pancreatic body/tail cancer. A pooled data analysis was performed on individual data for patients who underwent DP-CAR for pancreatic body/tail cancer as identified by systematic literature search. A total of 32 articles involving 109 patients were eligible for inclusion. Postoperative morbidity and mortality were 53% and 4%, respectively. Preoperative abdominal and/or back pain was completely relieved immediately after surgery in 98% of patients. The 1, 3 and 5 years overall survival (OS) rates were 59%, 21% and 10%, and the median OS was 14 months. Patients who received neoadjuvant treatment had a median OS of 23 months. In conclusion, DP-CAR for locally advanced pancreatic body/tail cancer can be performed safely with low mortality and provides survival benefit when combined with neoadjuvant treatment. Keywords Pancreatic cancer · Celiac axis · Distal pancreatectomy · Prognostic factors
Introduction Pancreatic cancer (PCa) is the fourth most common cause of cancer-related death in the Western world, with an estimated 53,000 new cases and 42,000 deaths in the year 2016 [1]. Microscopical radical resection (R0) is essential to improve long-term survival. Given its anatomic location and natural history, locally advanced pancreatic body/tail cancer often involves the common hepatic artery (CHA) and/or celiac axis (CA). In this situation, distal pancreatectomy with en bloc celiac axis resection (DP-CAR) is warranted to achieve oncological clearance [2–15]. However, the clinical importance of this procedure remains debatable because of the small sample size of previous studies. The aim of the present study was to analyze the perioperative and long-term outcomes of DP-CAR for pancreatic body/tail cancer and Jianfa Lan and Yufeng Chen contributed equally to this study. * Yanming Zhou [email protected] 1
Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
2
identify factors associated with survival in a relatively large number of patients by performing a systematic review of the literature available.
Methods Systematic search strategy PubMed database was used to search the relevant literature published in English from January 1990 to December 2019. The study was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines [16]. Search terms used were: pancreatic cancer, distal pancreatectomy, and celiac axis resection. The references of articles re
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