Detailed Abstract
[BP Best Oral Presentation - Biliary & Pancreas (Biliary Disease/Surgery)]
[BP BEST OP 6] Distal pancreatectomy with celiac axis resection (DP-CAR) in the era of neoadjuvant chemotherapy: What decides proper candidates for curative surgery? – A Korean nationwide investigation
So Jeong YOON1 , Sang-Jae PARK2 , Yoo-Seok YOON3 , Jin-Young JANG4 , Tae-Ho HONG5 , Dae Wook HWANG6 , Hee Joon KIM7 , Hongbeom KIM1 , Sang Hyun SHIN1 , Jin Seok HEO1 , In Woong HAN*1
1 Division Of Hepatobiliary-pancreatic Surgery, Department Of Surgery, Samsung Medical Center, Sungkyunkwan University School Of Medicine, REPUBLIC OF KOREA
2 Center For Liver Cancer, National Cancer Center, REPUBLIC OF KOREA
3 Department Of Surgery, Seoul National University Bundang Hospital, Seoul National University College Of Medicine, REPUBLIC OF KOREA
4 Department Of Surgery, Seoul National University Hospital, Seoul National University College Of Medicine, REPUBLIC OF KOREA
5 Department Of HBP Surgery, Department Of Surgery, Seoul St. Mary's Hospital, College Of Medicine, The Catholic University, REPUBLIC OF KOREA
6 Division Of Hepatobiliary And Pancreatic Surgery, Department Of Surgery, Asan Medical Center, University Of Ulsan College Of Medicine, REPUBLIC OF KOREA
7 Division Of Hepato-Pancreato-Biliary Surgery, Department Of Surgery, Chonnam National University Hospital, REPUBLIC OF KOREA
Background : As systemic treatment for pancreatic cancer advances, distal pancreatectomy with celiac axis resection (DP-CAR) has been considered to be a curative-intent surgical option for advanced pancreatic cancer. This study aimed to review surgical and oncologic outcomes of DP-CAR based on a Korean nationwide data.
Methods : We collected data of patients who underwent DP-CAR for pancreatic cancer between 2007 and 2021 at seven major hospitals in Korea. Clinicopathological characteristics, postoperative complications, and data on survival of the patients were retrospectively reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications and survival.
Results : A total of 75 patients, consisting mainly of borderline resectable (n = 32) or locally advanced (n = 30) pancreatic cancer, were included in the analysis. Forty-two (56.0%) patients underwent neoadjuvant treatment (NAT). There were 20 (26.7%) patients with Clavien-Dindo grade ≥ 3 complications, including four patients with ischemic gastropathy, two with hepatic ischemia and two with procedure-related mortalities. Neoadjuvant chemotherapy increased the risk of postoperative complications (p = 0.028). The median recurrence-free and overall survival were 7 and 19 months, with 5-year survival rate of 13% and 24%, respectively. In NAT group, CA 19-9 decrease and post-NAT maximum standardized uptake value (SUVmax) in positron emission tomography (PET) were associated with survival after surgical resection.
Conclusions : Despite the possibility of major complications, DP-CAR could be a feasible option for achieving curative resection with fair survival outcomes in patients with borderline resectable or locally advanced pancreatic cancer. Further study is necessary to investigate the safety of the procedure and to identify proper surgical candidates with potential survival gains.
Methods : We collected data of patients who underwent DP-CAR for pancreatic cancer between 2007 and 2021 at seven major hospitals in Korea. Clinicopathological characteristics, postoperative complications, and data on survival of the patients were retrospectively reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications and survival.
Results : A total of 75 patients, consisting mainly of borderline resectable (n = 32) or locally advanced (n = 30) pancreatic cancer, were included in the analysis. Forty-two (56.0%) patients underwent neoadjuvant treatment (NAT). There were 20 (26.7%) patients with Clavien-Dindo grade ≥ 3 complications, including four patients with ischemic gastropathy, two with hepatic ischemia and two with procedure-related mortalities. Neoadjuvant chemotherapy increased the risk of postoperative complications (p = 0.028). The median recurrence-free and overall survival were 7 and 19 months, with 5-year survival rate of 13% and 24%, respectively. In NAT group, CA 19-9 decrease and post-NAT maximum standardized uptake value (SUVmax) in positron emission tomography (PET) were associated with survival after surgical resection.
Conclusions : Despite the possibility of major complications, DP-CAR could be a feasible option for achieving curative resection with fair survival outcomes in patients with borderline resectable or locally advanced pancreatic cancer. Further study is necessary to investigate the safety of the procedure and to identify proper surgical candidates with potential survival gains.
SESSION
BP Best Oral Presentation
Room A 3/23/2023 11:00 AM - 12:10 PM