Distal pancreatectomy with celiac axis resection(DP-CAR) for pancreatic cancer: An analysis of 40 cases / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To assess the safety and efficacy of distal pancreatectomy with celiac axis resection(DP-CAR).METHODS: The clinical and pathological data of 40 patients with pancreatic cancer who underwent DP-CAR at the Changhai Hospital affiliated to the Naval Military Medical University from January 2012 to December 2016 were analyzed retrospectively.The postoperative incidence of complications,mortality and overall survival were analyzed respectively.RESULTS: The incidence of complication in the 40 patients(Clavien-Dindo score≥2) was 32.5%(13 cases)including 1 case(2.5%) died of liver failure in 90 days after surgery due to hepatic ischemia,6 cases(15.0%) of grade B or above pancreatic fistula,7 cases(17.5%) of gastric emptying disorder,6 cases(15,0%) of severe abdominal infection,4 cases(10.0%) of chyle leakage,and 4 cases(10%) of postpancreatectomy hemorrhage(PPH).Total median survival was19.1 months(IQR 8.9,30.8 months),one-year,three-year and five-year survival rate62.5%,17.5% and 5.0%.Patients of T4(median survivalT4 14.2 months vs.T1-3 24.1 months,P=0.0225),lymph node metastasis of N1-2(median survivalN1-2 8.8 months vs.NO 23.2 months,P=0.00967) had a worse median survival time.CONCLUSION: In high-selective patients with pancreatic body/tail cancer,the morbidity,mortality and median survival after DP-CAR surgery are acceptable,and patients with T4 and regional lymph nodes enlargement in preoperative imaging evaluation should be performed neoadjuvant therapy,and then be re-evaluated before DP-CAR.