Distal Pancreatectomy with En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Adenocarcinoma Following Neoadjuvant Therapy

Joel M. Baumgartner, Alyssa Krasinskas, Mustapha Daouadi, Amer Zureikat, Wallis Marsh, Kenneth Lee, David Bartlett, A. James Moser, Herbert J. Zeh

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Background: Celiac trunk encasement by adenocarcinoma of the pancreatic body is generally regarded as a contraindication for surgical resection. Recent studies have suggested that a subset of stage III patients will succumb to their disease in the absence of distant metastases. We hypothesized that patients with stage III tumors invading the celiac trunk, who are free of distant disease following neoadjuvant therapy, may derive prolonged survival benefit from aggressive surgical resection. Methods: We performed a retrospective review of distal pancreatectomies with en bloc celiac axis resection for pancreatic adenocarcinoma. Results: Eleven patients underwent a distal pancreatectomy with en bloc celiac axis resection after completing neoadjuvant chemoradiation therapy. Median operative time was 8 h, 14 min, and median estimated blood loss was 700 ml. Median length of stay was 9 days. Five patients (45%) had postoperative complications; three were Clavien grade I. Four patients (35%) had pancreatic leaks; two were ISGPF grade B, and two were grade A. There were two 90-day perioperative deaths. Ten patients had R0 resections (91%). After a median follow-up of 41 weeks, six patients recurred. Four of the five patients with SMAD4 loss recurred, and two of the five patients with intact SMAD4 recurred. Median disease-free and overall survival were 21 weeks and 26 months, respectively. Conclusions: Resection of pancreatic body adenocarcinoma with celiac axis resection is technically feasible with acceptable perioperative morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)1152-1159
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume16
Issue number6
DOIs
StatePublished - Jun 1 2012
Externally publishedYes

Keywords

  • Appleby
  • Celiac artery resection
  • Neoadjuvant therapy
  • Pancreatic cancer

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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