Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis

Klompmaker, Sjors; Peters, Niek A.; Van Hilst, Jony; Bassi, Claudio; Boggi, Ugo; Busch, Olivier R.; Niesen, Willem; Van Gulik, Thomas M.; Javed, Ammar A.; Kleeff, Jorg; Kawai, Manabu; Lesurtel, Mickael; Lombardo, Carlo; Moser, A. James; Okada, Ken-ichi; Popescu, Irinel; Prasad, Raj; Salvia, Roberto; Sauvanet, Alain; Sturesson, Christian; Weiss, Matthew J.; Zeh, Herbert J.; Zureikat, Amer H.; Yamaue, Hiroki; Wolfgang, Christopher L.; Hogg, Melissa E.; Besselink, Marc G.; Gerritsen, Sarah L.; Adham, Mustapha; Teresa Albiol, M.; Berrevoet, Frederik; Cesaretti, Manuela; Dalla Valle, Raffaele; Darnis, Benjamin; Diener, Markus K.; Del Chiaro, Marco; Hackert, Thilo H.; Gruetzmann, Robert; Dumitrascu, Traian; Friess, Helmut; Hirono, Seiko; Ivanecz, Arpad; Karayiannakis, Anastasios; Fusai, Giuseppe K.; Labori, Knut J.; Lopez-Ben, Santiago; Mabrut, Jean-Yves; Miyazawa, Motoki; Pardo, Fernando; Perinel, Julie; Roeyen, Geert     «

Klompmaker, Sjors; Peters, Niek A.; Van Hilst, Jony; Bassi, Claudio; Boggi, Ugo; Busch, Olivier R.; Niesen, Willem; Van Gulik, Thomas M.; Javed, Ammar A.; Kleeff, Jorg; Kawai, Manabu; Lesurtel, Mickael; Lombardo, Carlo; Moser, A. James; Okada, Ken-ichi; Popescu, Irinel; Prasad, Raj; Salvia, Roberto; Sauvanet, Alain; Sturesson, Christian; Weiss, Matthew J.; Zeh, Herbert J.; Zureikat, Amer H.; Yamaue, Hiroki; Wolfgang, Christopher L.; Hogg, Melissa E.; Besselink, Marc G.; Gerritsen, Sarah L.; Adha...     »

BackgroundDistal 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 and assessed oncologic outcomes.MethodsThis 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.ResultsFor 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 19months (95 CI, 15-25months).ConclusionsWhen 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.     «

BackgroundDistal 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 and assessed oncologic outcomes.MethodsThis multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers...     »