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Distal pancreas–coeliac axis resection with preoperative selective embolization of the coeliac axis: a single high-volume centre experience

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Abstract

Background

Patients with ductal adenocarcinoma in the body and/or tail of the pancreas with involvement of the common hepatic artery and/or celiac axis have until recently been considered unresectable. In selected cases, distal pancreatectomy (DP) with en bloc celiac axis resection (DP-CAR) may be an option to achieve R0 resection.

Methods

Patients with tumours in the body and/or tail of the pancreas locally advanced with involvement of the common hepatic artery and/or celiac axis, with no distant metastases, were evaluated for DP-CAR procedures. Preoperative embolization was performed 10–14 days prior to surgery to enhance collateral arterial supply for the liver and stomach.

Results

A total of 21 patients went through DP-CAR of whom 15 were preoperatively embolized. R0 resection vas achieved in 76% of the patients comparable to our standard distal pancreatectomies. The DP-CAR patients had a significant longer postoperative hospital stay, but no difference in major complications, including pancreatic fistulas compared with our standard distal pancreatectomies. No 30 nor 90 days postoperative mortality were recorded. Median survival in patients who underwent DP and DP-CAR procedures was 24.0 and 23.5 months, respectively (P > 0.5).

Conclusion

Outcomes after DP-CAR are comparable to standard distal pancreatectomies. DP-CAR after preoperative embolization is feasible and may in selected patients be a good option for treating patients with tumours in the body and/or tail of the pancreas with central arterial involvement.

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References

  1. Brennan MF, Moccia RD, Klimstra D (1996) Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 223(5):506–511 discussion 511–512

    Article  CAS  Google Scholar 

  2. Johnson CD, Schwall G, Flechtenmacher J, Trede M (1993) Resection for adenocarcinoma of the body and tail of the pancreas. Br J Surg 80(9):1177–1179

    Article  CAS  Google Scholar 

  3. Lillemoe KD, Kaushal S, Cameron JL et al (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229(5):693–698 discussion 698–700

    Article  CAS  Google Scholar 

  4. Shoup M, Conlon KC, Klimstra D et al (2003) Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg 7(8):946–952 discussion 952

    Article  Google Scholar 

  5. Takahashi T, Ishikura H, Motohara T, Okushiba SI, Dohke M, Katoh H (1997) Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol 65:164–170

    Article  CAS  Google Scholar 

  6. Sasson AR, Hoffman JP, Ross EA et al (2002) En bloc resection for locally advanced cancer of the pancreas: is it worthwhile? J Gastrointest Surg 6(2):147–157 discussion 157–158

    Article  Google Scholar 

  7. Appleby LH (1953) The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer. 6(4):704–707

    Article  CAS  Google Scholar 

  8. Nimura Y, Hattori T, Miura K et al (1976) A case of advanced carcinoma of the body and tail of the pancreas resected by the Appleby operation (in Japanese). Operation 30:885–889

    Google Scholar 

  9. Katz MH, Marsh R, Herman JM et al (2013) Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol 20(8):2787–2795

    Article  Google Scholar 

  10. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic Surgery (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 155(6):977–988

    Article  Google Scholar 

  11. Hirano S, Kondo S, Hara T, Ambo Y, Tanaka E, Shichinohe T, Suzuki O, Hazama K (2007) Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg 246(1):46–51

    Article  Google Scholar 

  12. Kondo S, Katoh H, Shimizu T et al (2000) Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepatogastroenterology 47(35):1447–1449

    PubMed  CAS  Google Scholar 

  13. Yamagami T, Yoshimatsu R, Kajiwara K et al (2015) Arteriography after embolization before distal pancreatectomy with en bloc celiac axis resection. Minim Invasive Ther Allied Technol 24(6):350–355

    Article  Google Scholar 

  14. Okada K, Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H (2014) Preservation of the left gastric artery on the basis of anatomical features in patients under-going distal pancreatectomy with celiac axis en-bloc resection (DP-CAR). World J Surg 38:2980–2985

    Article  Google Scholar 

  15. Nakamura T, Hirano S, Noji T, Asano T, Okamura K, Tsuchikawa T, Murakami S, Kurashima Y, Ebihara Y, Nakanishi Y, Tanaka K, Shichinohe T (2016) Distal pancreatectomy with en bloc celiac axis resection (modified Appleby procedure) for locally advanced pancreatic body cancer: a single-center review of 80 consecutive patients. Ann Surg Oncol 23(Suppl5):969–975

    Article  Google Scholar 

  16. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  17. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 142(5):761–768. https://doi.org/10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  18. Wente MN, Veit JA, Bassi C, Dervenis C (2007) Postpancreatectomy hemorrhage (PPH)—an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 142(1):20–25. https://doi.org/10.1016/j.surg.2007.02.001

    Article  PubMed  Google Scholar 

  19. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surg. 161(3):584–591

    Article  Google Scholar 

  20. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132

    Article  CAS  Google Scholar 

  21. Compton C, Byrd D, Garcia-Aguilar J, Kurtzman S, Olawaiye A, Washington M (2010) Exocrine and endocrine pancreas. In: Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A (eds) AJCC cancer staging manual, 7th edn. Springer, New York, pp 241–249. https://doi.org/10.1007/978-1-4614-2080-4

    Chapter  Google Scholar 

  22. The Royal College of Pathologists (2002) Standards and minimum datasets for reporting cancers minimum dataset for the histopathological reporting of pancreatic, ampulla of Vater and bile duct carcinoma. The Royal College of Pathologists, London 261035

    Google Scholar 

  23. Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA (2012) Artery first approaches to pancreatoduodenectomy. Br J Surg 99:1027–1035

    Article  CAS  Google Scholar 

  24. Strasberg SM, Linehan DC, Hawkins WG (2007) Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 204:244–249

    Article  Google Scholar 

  25. Barst RJ, Rubin LJ, Long WA, McGoon MD, Rich S, Badesch DB, Groves BM, Tapson VF, Bourge RC, Brundage BH, Koerner SK, Langleben D, Keller CA, Murali S, Uretsky BF, Clayton LM, Jöbsis MM, Blackburn SD, Shortino D, Crow JW, Primary Pulmonary Hypertension Study Group (1996) A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. The primary pulmonary hypertension study group. N Engl J Med 334:296–302

    Article  CAS  Google Scholar 

  26. Barst RJ, Rubin LJ, McGoon MD, Caldwell EJ, Long WA, Levy PS (1994) Survival in primary pulmonary hypertension with long-term continuous intravenous prostacyclin. Ann Intern Med 121:409–415

    Article  CAS  Google Scholar 

  27. Katz MH, Marsh R, Herman JM et al (2013 Aug) Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol 20(8):2787–2795. https://doi.org/10.1245/s10434-013-2886-9

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bockhorn M, Uzunoglu FG, Adham M et al (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988 (2a)

    Article  Google Scholar 

  29. Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F, Santos DD, Allen JN, Blaszkowsky LS, Clark JW, Faris JE, Goyal L, Kwak EL, Murphy JE, Ting DT, Wo JY, Zhu AX, Warshaw AL, Lillemoe KD, Castillo CFD (2015) Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 261(1):12–17. https://doi.org/10.1097/sla.0000000000000867

    Article  PubMed  PubMed Central  Google Scholar 

  30. Katz MH, Fleming JB, Bhosale P et al (2012) Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer. 118(23):5749–5756

    Article  Google Scholar 

  31. Klompmaker S, van Hilst J, Gerritsen SL et al (2018) Outcomes after distal pancreatectomy with celiac axis resection for pancreatic cancer: a pan-European retrospective cohort study. Ann Surg Oncol 25:1440–1447. https://doi.org/10.1245/s10434-018-6391-z

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ocuin LM, Miller-Ocuin JL, Novak SM, Bartlett DL, Marsh JW, Tsung A, Lee KK, Hogg ME, Zeh HJ, Zureikat AH (2016) Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: a single institutional assessment of perioperative outcomes and survival. HPB. 18(10):835–842

    Article  Google Scholar 

  33. Abrams RA, Lowy AM, O’Reilly EM et al (2009) Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 16:1751–1756

    Article  Google Scholar 

  34. Egorov VI, Petrov RV, Lozhkin MV et al (2013) Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy. World J Gastrointest Surg 27(5):51–61

    Article  Google Scholar 

  35. Kondo S, Katoh H, Hirano S et al (2003) Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body. Langenbeck's Arch Surg 388:205

    Article  Google Scholar 

  36. Takahashi H, Shida D, Tagawa K, Suzuki T (2016 May) Hemodynamics of mesenteric traction syndrome measured by FloTrac sensor. J Clin Anesth 30:46–50

    Article  Google Scholar 

  37. Eipel C, Abshagen K, Vollmar B (2010) Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol 16:6046–6057

    Article  Google Scholar 

  38. Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O'Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Büchler MW (2017) Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 6736(16):1–14. https://doi.org/10.1016/s0140-6736(16)32409-6

    Article  Google Scholar 

  39. Hirano S, Kondo TE et al (2010) Postoperative bowel function and nutritional status following distal pancreatectomy with en-bloc celiac axis resection. Dig Surg 27:212–216. https://doi.org/10.1159/000265573

    Article  PubMed  Google Scholar 

  40. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127

    Article  CAS  Google Scholar 

  41. Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364:2128–2137

    Article  CAS  Google Scholar 

  42. Krautz C, Nimptsch U, Weber GF, Mansky T, Grützmann R (2018 Mar) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417

    Article  Google Scholar 

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  1. Department of Surgery CTx, Rigshospitalet, Copenhagen, Denmark

    JH Storkholm, SK Burgdorf & CP Hansen

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Storkholm, J., Burgdorf, S. & Hansen, C. Distal pancreas–coeliac axis resection with preoperative selective embolization of the coeliac axis: a single high-volume centre experience. Langenbecks Arch Surg 405, 635–645 (2020). https://doi.org/10.1007/s00423-020-01919-7

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