[Indications for and postoperative problems of distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer].

ABSTRACT

To treat locally advanced cancer of the pancreatic body involving the common hepatic artery and/or celiac axis with perineural invasion in the nerve plexus surrounding these arteries, we have employed distal pancreatectomy with en bloc celiac axis resection (DP-CAR) without arterial reconstruction. DP-CAR has been performed in patients in whom the gastroduodenal artery and superior mesenteric artery could be preserved. Between April 1998 and December 2007, 37 patients underwent DP-CAR in our institution. The surgical margins were histologically clear (R0) in 35 (95%) patients. The postoperative morbidity rate was 59%. The primary complications were pancreatic fistula occurring in 19 patients and ischemic gastropathy in 5. Estimated overall 1- and 5-year survival rates were 72% and 17%, respectively, and the median survival was 21 months. The most common site of recurrence was the liver, where recurrence appeared significantly earlier than in other metastatic sites. DP-CAR, with its potential to achieve complete local control, has been confirmed to be advantageous only in cases that are unlikely to develop hepatic metastasis. In principle, since 2006 patients who have undergone DP-CAR also receive postoperative adjuvant chemotherapy. Patients must achieve feasible general status within 3 months after DP-CAR to be able to start adjuvant chemotherapy.