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Feasibility and safety of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) combined with neoadjuvant therapy for borderline resectable and unresectable pancreatic body/tail cancer

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Abstract

Purpose

Pancreatic body/tail cancer commonly invades the hepatic artery or celiac artery, making surgical resection difficult. Distal pancreatectomy with celiac axis resection (DP-CAR) has recently been performed to achieve curative resection of these tumors. However, the safety and efficacy remain unclear. This study aimed to clarify the efficacy and safety of DP-CAR, mainly focusing on the combination with neoadjuvant therapy (NAT).

Methods

We retrospectively reviewed 31 consecutive patients with pancreatic ductal adenocarcinoma who underwent DP-CAR between 2010 and 2016. Data from 7 patients who underwent DP-CAR without NAT were used as a reference (upfront surgery, US).

Results

Gemcitabine + S-1 (GS) (n = 17) and gemcitabine + albumin-bound paclitaxel (GnP) (n = 8) were frequently used as NAT. DP-CAR following NAT was performed safely with 1 death, resulting in a mortality rate of 3%. The median survival time (MST) in the NAT group was 38.6 months, while that in the US group was 15.6 months. The NAT group had a high R0 resection rate (74%), while only 1 of 7 cases in the US group achieved R0 resection. Within the NAT group, patients treated with GS showed favorable overall survival with 39.5 months of MST, while that of patients treated with GnP was 19.8 months.

Conclusion

The combination of NAT and DP-CAR was feasible and safe for pancreatic body/tail cancer invading the celiac artery and/or hepatic artery. This strategy should be further assessed for the optimal regimen and duration of NAT in prospective studies.

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Acknowledgements

The authors thank the members of the Department of General Surgery, Chiba University Hospital, Chiba, Japan, for helping this study.

Funding

This research was partly supported by the Grant-in-Aid for scientific research (B:Grant No.: JP17H04287 and C: Grant No.: JP15K10180) of JSPS (Japan Society for the Promotion of Science) KAKENHI.

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Authors and Affiliations

  1. Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Hideyuki Yoshitomi, Nozomu Sakai, Shingo Kagawa, Shigetsugu Takano, Atsuhiko Ueda, Atsushi Kato, Katsunori Furukawa, Tsukasa Takayashiki, Satoshi Kuboki, Masaru Miyzaki & Masayuki Ohtsuka

  2. Digestive Diseases Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan

    Atsushi Kato & Masaru Miyzaki

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  1. Hideyuki Yoshitomi
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Contributions

Study conception and design: HY and MO; acquisition of data: HY, NS, SK, AU, and TT; analysis and interpretation of data: HY, KF, SK, and AK; drafting of the manuscript: HY and ST; critical revision of the manuscript: MM and MO.

Corresponding author

Correspondence to Masayuki Ohtsuka.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Yoshitomi, H., Sakai, N., Kagawa, S. et al. Feasibility and safety of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) combined with neoadjuvant therapy for borderline resectable and unresectable pancreatic body/tail cancer. Langenbecks Arch Surg 404, 451–458 (2019). https://doi.org/10.1007/s00423-019-01775-0

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