Abstract
Background
Few comparison studies have been carried out on patients with distal pancreatectomy (DP) combined with celiac axis (CA) resection. The aim of this study was to assess the safety and efficacy of this extended procedure in treatment of advanced carcinoma of the body/tail of the pancreas.
Methods
This was a retrospective analysis of 206 patients with carcinoma of the body/tail of the pancreas from January 2003 through June 2008. Patients were divided into three groups based on the relationship of tumor and CA/common hepatic artery (CHA) as well as different treatment strategies. Data for operation time, blood loss, complications, and survival time were collected and statistically analyzed.
Results
Sixty-five patients (31.6%) received radical distal pancreatectomy (DP), including 11 patients who underwent DP combined with celiac axis resection (group A) and 54 patients who received conventional DP (group B). Twenty patients did not undergo DP because of CA and/or CHA invasion only (group C). Group A had longer mean operative time than group B (323 versus 225 min, P = 0.000); there was no difference in mean estimated blood loss, percentage of pancreatic fistula or median survival time (14 versus 15 months, P = 0.197). However, group A had significantly prolonged median survival time compared with the 20 patients in group C (14 versus 5 months, P = 0.013), and quality of life was also dramatically improved.
Conclusions
DP combined with CA resection can be safely performed in certain patients with carcinoma of body/tail of the pancreas and significantly improves patient survival and quality of life.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Appleby AH. The celiac axis in the expansion of the operation for gastric carcinoma. Cancer. 1953;6(8):704–7.
Hishinuma S, Ogata Y, Matsui J, Ozawa I, Inada T, Shimizu H, et al. Two cases of cancer of the pancreatic body undergoing gastric preservation with distal pancreatectomy combined with resection fo the celiac axis. Jpn J Gastroenterol Surg. 1991;24(12):2782–6.
Konishi M, Kinoshita T, Nakagori T, Inoue K, Oda T, Kimata T, et al. Distal pancreatectomy with resection of the celiac axis and reconstruction of the hepatic artery for carcinoma of the body and tail of the pancreas. J Hepatobiliary Pancreat Surg. 2000;7(2):183–7.
Yekebas EF, Bogoevski D, Cataldegirmen G, Kunze C, Marx A, Vashist YK, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247(2):300–9.
Hirano S, Kondo S, Hara T, Ambo Y, Tanaka E, Shichinohe T, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg. 2007;246(1):46–51.
Tempero M, Arnoletti JP, Ben-Josef E, Bhargava P, Casper ES, Kim P, et al. Pancreatic adenocarcinoma Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2007;5(10):998–1033.
Wood HE, Gupta S, Kang JY, Quinn MJ, Maxwell JD, Mudan S, et al. Pancreatic cancer in England and Wales 1975–2000: patterns and trends in incidence, survival and mortality. Aliment Pharmacol Ther. 2006;23(8):1205–14.
Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg. 1999;189(1):1–7.
Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4(6):567–79.
Nordback IH, Hruban RH, Boimmt JK, Pitt HA, Cameron JL. Carcinoma of the body and tail of the pancreas. Am J Surg. 1992;164(1):26–31.
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229(5):693–8.
Wu YL, Yan HC, Chen LR, Gao SL, Chen J, Dong X. Extended Appleby’s operation for pancreatic cancer involving celiac axis. J Surg Oncol. 2007;96(5):442–6.
Yamaguchi K, Nakano K, Kobayashi K, Ogura Y, Konomi H, Sugitani A, et al. Appleby operation for pancreatic body-tail carcinoma: report of three cases. Surg Today. 2003;33(11):873–8.
Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Maeyama Y, et al. Ischemic gastropathy after distal pancreatectomy with celiac axis resection. Surg Today. 2004;34(4):337–40.
Bryant DP, Cooney RN, Smith JS, Haluck AR. Traumatic proper hepatic artery occlusion: case report. J Trauma. 2001;50(4):735–7.
Hirai I, Kimura W, Kamiga M, Mizutani M, Takeshita A, Watanabe T, et al. The significance of intraoperative Doppler ultrasonography in evaluating hepatic arterial flow when assessing the indications for the Appleby procedure for pancreatic body cancer. J Hepatobiliary Pancreat Surg. 2005;12(1):55–60.
Kondo S, Katoh H, Shimizu T, Omi M, Hirano S, Ambo Y, et al. Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepato-Gastroenterology. 2000;47(35):1447–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wu, X., Tao, R., Lei, R. et al. Distal Pancreatectomy Combined with Celiac Axis Resection in Treatment of Carcinoma of the Body/Tail of the Pancreas: A Single-Center Experience. Ann Surg Oncol 17, 1359–1366 (2010). https://doi.org/10.1245/s10434-009-0840-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-009-0840-7