15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer—A Korean Nationwide Investigation
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | N (%) or Mean (±SD) | Variables | N (%) or Mean (±SD) |
---|---|---|---|
Age at operation | 62.6 (±8.8) | Initial resectability | |
Sex | Resectable | 2 (2.7) | |
Male | 38 (50.6) | Borderline-resectable | 42 (56.0) |
Female | 37 (49.4) | Locally-advanced | 30 (40.0) |
BMI (kg/m2) | 23.6 (±2.9) | Unknown | 1 (1.3) |
ASA score | |||
I | 7 (9.3) | In NAT group (n = 42) | |
II | 60 (80.0) | Initial resectability | |
III | 6 (8.0) | Borderline-resectable | 18 (42.9) |
Underlying cardiovascular disease | 28 (37.3) | Locally-advanced | 23 (54.8) |
Underlying DM | 33 (44.0) | Unknown | 1 (2.3) |
Post-NAT resectability | |||
Preop. CA 19-9 (IU/mL) | 164.7 (±419.2) | Borderline-resectable | 26 (61.9) |
Elevated (>37 IU/mL) | 31 (41.3) | Locally-advanced | 16 (38.1) |
Preop. NLR | 2.2 (±1.5) | ||
Preop. PLR | 125.3 (±57.4) | ||
Neoadjuvant treatment | 42 (56.0) | ||
Chemotherapy | 27 (36.0) | ||
Chemo-radiotherapy | 15 (20.0) |
Variables | N (%) or Mean (±SD) | Variables | N (%) or Mean (±SD) |
---|---|---|---|
Operative findings | Pathology | ||
Arterial reconstruction | Tumor size, cm | 3.6 (±1.6) | |
Aorta to CHA, with graft | 2 (2.7) | LN metastasis | 52 (69.3) |
PV resection | 20 (26.7) | Tumor differentiation | |
WD | 7 (9.3) | ||
Combined organ resection | MD | 52 (69.3) | |
Colon | 5 (6.7) | PD/Undifferentiated | 12 (16.0) |
Stomach | 4 (5.3) | PNI | 67 (89.3) |
LVI | 35 (46.7) | ||
Operation time, min | 298.4 (±98.9) | ||
Estimated blood loss, mL | 582.3 (±509.1) | AJCC 8th Stage | |
RBC transfusion | 18 (24.0) | No residual tumor | 2 (2.7) |
IA/IB | 7 (9.3)/8 (10.6) | ||
IIA/IIB | 3 (4.0)/32 (42.7) | ||
III | 18 (24.0) | ||
IV (M1 disease) | 5 (6.7) | ||
R0 resection | 49 (65.3) | ||
Pt. with upfront surgery | 18 (54.5) | ||
Pt. with NAT | 31 (73.8) | ||
Adjuvant treatment | 54 (72.0) | ||
Chemotherapy | 39 (52.0) | ||
Radiotherapy | 2 (2.7) | ||
Chemo-radiotherapy | 13 (173) |
Variables | N (%) or Mean (±SD) | Details on Mortality Cases |
---|---|---|
Overall complication | 47 (62.7) | Case #1—Procedure-related F/81—Upfront surgery for BRPC CR-POPF and Gastric ischemia Sepsis—Multi organ failure Expired on POD #20 |
Complications, C-D grade ≥ 3 | 20 (26.7) | |
Re-opeartion | 2 (2.7) | |
Overall 90-day mortality | 3 (4.0) | |
Procedure-related 90-day mortality | 2 (2.7) | |
Gastropathy | 10 (13.3) | Case #2—Procedure-related M/70—Neoadjuvant CCRT for BRPC Septic shock due to CR-POPF Expired on POD #9 |
Delayed gastric emptying | 6 (8.0) | |
Gastric ischemia (requiring non-surgical management) | 3 (4.0) | |
Gastric perforation (requiring re-operation) | 1 (1.3) | |
Hepatic ischemia (requiring conservative management) | 2 (2.7) | |
Thrombotic occlusion—hepatic artery/reconstructed artery | 0 (0) | |
Thrombotic occlusion—PV | 4 (5.3) | |
Case #3 F/71—Neoadjuvant CCRT for LAPC Septic shock due to postop. pneumonia Expired on POD #20 | ||
CR-POPF | 20 (26.7) | |
POPF—grade B | 17 (22.7) | |
POPF—grade C | 3 (4.0) | |
Length of hospital stay, days | 18.1 (±13.7) | |
Re-admission within 90 days | 14 (18.7) |
Variables | Univariable p | OR | 95% CI | Multivariable p |
---|---|---|---|---|
Age | 0.129 | |||
Sex, male (ref. female) | 0.651 | |||
BMI | 0.928 | |||
ASA score | 0.161 | |||
Underlying cardiovascular diseases | 0.774 | |||
Underlying Diabetes Mellitus | 0.529 | |||
Preop. elevated CA 19-9 | 0.152 | |||
Preop. NLR | 0.493 | |||
Preop. PLR | 0.958 | |||
NAT—chemotherapy | 0.031 | 4.445 | 1.176–16.795 | 0.028 |
NAT—CCRT | 0.349 | 2.350 | 0.481–11.469 | 0.291 |
Portal vein resection | 0.092 | 2.756 | 0.847–8.968 | 0.092 |
Arterial reconstruction | - | |||
Estimated blood loss | 0.994 | |||
RBC transfusion | 0.103 |
Variables | Recurrence-Free Survival | Overall Survival | ||||||
---|---|---|---|---|---|---|---|---|
uni p | HR | 95% CI | p | uni p | HR | 95% CI | p | |
Age | 0.765 | 0.151 | ||||||
Sex, male (ref. female) | 0.259 | 0.419 | ||||||
BMI | 0.526 | 0.587 | ||||||
ASA score | 0.118 | 0.615 | ||||||
Underlying CVD | 0.422 | 0.253 | ||||||
Underlying DM | 0.719 | 0.763 | ||||||
Preop. elevated CA 19-9 | 0.065 | 3.047 | 0.987–9.409 | 0.053 | 0.185 | |||
Preop. NLR | 0.190 | 0.525 | ||||||
Preop. PLR | 0.908 | 0.524 | ||||||
Preop. PV invasion * | 0.719 | 0.702 | ||||||
Preop. SUVmax (PET) | 0.012 | 1.548 | 1.061–2.260 | 0.024 | 0.086 | 1.387 | 0.955–2.016 | 0.086 |
NAT regimen, FOLFIRINOX (ref. others) | 0.817 | 0.115 | ||||||
Combined RT | 0.560 | 0.937 | ||||||
Biologic response to NAT (decrease in CA 19-9) | 0.456 | 0.021 | 0.114 | 0.017–0.772 | 0.026 | |||
Radiologic response to NAT (radiologic downstaging) | 0.768 | 0.237 | ||||||
Metabolic response to NAT (decrease in SUVmax) | 0.473 | 0.251 |
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Yoon, S.J.; Park, S.-J.; Yoon, Y.-S.; Hong, T.-H.; Jang, J.-Y.; Kim, H.J.; Heo, J.S.; Hwang, D.W.; Han, I.W. 15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer—A Korean Nationwide Investigation. Cancers 2023, 15, 3850. https://doi.org/10.3390/cancers15153850
Yoon SJ, Park S-J, Yoon Y-S, Hong T-H, Jang J-Y, Kim HJ, Heo JS, Hwang DW, Han IW. 15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer—A Korean Nationwide Investigation. Cancers. 2023; 15(15):3850. https://doi.org/10.3390/cancers15153850
Chicago/Turabian StyleYoon, So Jeong, Sang-Jae Park, Yoo-Seok Yoon, Tae-Ho Hong, Jin-Young Jang, Hee Joon Kim, Jin Seok Heo, Dae Wook Hwang, and In Woong Han. 2023. "15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer—A Korean Nationwide Investigation" Cancers 15, no. 15: 3850. https://doi.org/10.3390/cancers15153850