Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis
E-AHPBA DP-CAR study group
(2019) Annals of Surgical Oncology, volume 26, issue 3, pp. 772 - 781
(Article)
Abstract
BACKGROUND: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality
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and assessed oncologic outcomes. METHODS: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. RESULTS: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15-25 months). CONCLUSIONS: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.
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Keywords: Aged, Celiac Artery/surgery, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pancreatectomy/mortality, Pancreatic Neoplasms/pathology, Patient Selection, Retrospective Studies, Survival Rate, Treatment Outcome, Journal Article, Multicenter Study
ISSN: 1068-9265
Publisher: Springer New York
Note: Funding Information: ACKNOWLEDGMENT We acknowledge the office of the European-African Hepato-Pancreato-Biliary Association for its support and the Living With Hope (LWH) foundation and Cancer Center Amsterdam for providing travel grants. We are grateful to Sarah L. Gerritsen, Mustapha Adham, M. Teresa Albiol Quer, Frederik Ber-revoet, Manuela Cesaretti, Raffaele Dalla Valle, Benjamin Darnis, Markus K. Diener, Marco Del Chiaro, Thilo H. Hackert, Robert Grützmann, Traian Dumitrascu, Helmut Friess, Seiko Hirono, Arpad Ivanecz, Anastasios Karayiannakis, Giuseppe K. Fusai, Knut J. Labori, Santiago López-Ben, Jean-Yves Mabrut, Motoki Miyazawa, Willem Niesen, Fernando Pardo, Julie Perinel, and Geert Roeyen for data collection/provision and/or local study coordination. Funding Information: We acknowledge the office of the European-African Hepato-Pancreato-Biliary Association for its support and the Living With Hope (LWH) foundation and Cancer Center Amsterdam for providing travel grants. We are grateful to Sarah L. Gerritsen, Mustapha Adham, M. Teresa Albiol Quer, Frederik Berrevoet, Manuela Cesaretti, Raffaele Dalla Valle, Benjamin Darnis, Markus K. Diener, Marco Del Chiaro, Thilo H. Hackert, Robert Gr?tzmann, Traian Dumitrascu, Helmut Friess, Seiko Hirono, Arpad Ivanecz, Anastasios Karayiannakis, Giuseppe K. Fusai, Knut J. Labori, Santiago L?pez-Ben, Jean-Yves Mabrut, Motoki Miyazawa, Willem Niesen, Fernando Pardo, Julie Perinel, and Geert Roeyen for data collection/provision and/or local study coordination. Collaborators Sarah L. Gerritsen (Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands). Publisher Copyright: © 2019, The Author(s).
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