Efficacy of Neoadjuvant Chemotherapy in Distal Pancreatectomy with En Bloc Celiac Axis Resection (DP-CAR) for Locally Advanced Pancreatic Cancer

  • Shohei YoshiyaEmail author
  • Kengo Fukuzawa
  • Shoichi Inokuchi
  • Yukiko Kosai-Fujimoto
  • Kensaku Sanefuji
  • Kentaro Iwaki
  • Akira Motohiro
  • Shinji Itoh
  • Noboru Harada
  • Toru Ikegami
  • Tomoharu Yoshizumi
  • Masaki Mori
Original Article



Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) is an extended surgical procedure for patients with locally advanced cancer of the pancreatic body and tail. Recently, the usability of neoadjuvant chemotherapy (NAC) in pancreatic cancer was reported. The purpose of this study was to clarify the impact of NAC on surgical outcomes and prognosis in DP-CAR patients.


This study retrospectively reviewed 20 consecutive patients who underwent DP-CAR at a single institution.


Eleven of 20 patients (55.0%) received NAC. Their first regimens were gemcitabine (GEM) plus nab-PTX (n = 7, 63.6%), GEM plus S-1 (n = 3, 27.3%), and GEM (n = 1, 9.1%). Although two patients converted to a second regimen, none abandoned NAC due to adverse effects or could not undergo a planned procedure for disease progression. There were no significant differences in intraoperative variables, morbidity, including pancreatic fistula and delayed gastric emptying, and mortality between patients with and without NAC; however, patients with NAC had a significantly lower proportion of arterial invasion (p = 0.025), lymphatic invasion (p < 0.0001), and vascular invasion (p = 0.035). There were no significant differences in the induction rate of adjuvant chemotherapy (p = 0.201). The recurrence-free survival and overall survival rates in patients with NAC were significantly higher than in patients without NAC (p = 0.041 and p = 0.018, respectively).


DP-CAR following NAC was associated with a preferable prognosis and had no negative effect on surgical outcomes. Therefore, NAC in DP-CAR patients might be a beneficial and safe therapeutic strategy.


Neoadjuvant chemotherapy DP-CAR Appleby Pancreatic cancer 



Adjuvant chemotherapy


Borderline resectable disease


Common hepatic artery


Celiac axis


Computed tomography


Delayed gastric emptying


Distal pancreatectomy with en bloc celiac axis resection


Gastroduodenal artery




Gemcitabine plus S-1


Left gastric artery


Mean survival time


Neoadjuvant chemotherapy


The National Comprehensive Cancer Network


Pancreatic ductal adenocarcinoma


Pancreatic fistula




Portal vein


Superior mesenteric artery


Union for International Cancer Control


Unresectable disease



We thank H. Nikki March, PhD, from Edanz Group ( for editing a draft of this manuscript.

Author Contributions

S.Y. participated in the study conception and design, analysis, and drafting of the article.

K.F. participated in the study conception and design and critical revision of the manuscript.

S.I., Y.F., K.S, K.I., S.I., N.H., T.I., and T.Y. participated in the acquisition of data, analysis, and interpretation of data.

M.M participated in the critical revision of the manuscript.

Compliance with Ethical Standards

All patients provided written informed consent, and the study protocol was approved by the Ethical Committee of Oita Red Cross Hospital (IRB No. 189).

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Shohei Yoshiya
    • 1
    • 2
    Email author
  • Kengo Fukuzawa
    • 2
  • Shoichi Inokuchi
    • 1
    • 2
  • Yukiko Kosai-Fujimoto
    • 1
    • 2
  • Kensaku Sanefuji
    • 2
  • Kentaro Iwaki
    • 2
  • Akira Motohiro
    • 2
  • Shinji Itoh
    • 1
  • Noboru Harada
    • 1
  • Toru Ikegami
    • 1
  • Tomoharu Yoshizumi
    • 1
  • Masaki Mori
    • 1
  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of SurgeryOita Red Cross HospitalOitaJapan

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