Feasibility and safety of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) combined with neoadjuvant therapy for borderline resectable and unresectable pancreatic body/tail cancer
Feasibility and safety of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) combined with neoadjuvant therapy for borderline resectable and unresectable pancreatic body/tail cancer
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DOI：
10.1007/s00423-019-01775-0
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发表时间：
2019-06-01
影响因子：
2.3
通讯作者：
Ohtsuka, Masayuki
中科院分区：
文献类型：
--
作者：
Yoshitomi, Hideyuki;Sakai, Nozomu;Ohtsuka, Masayuki
目的胰腺体尾癌常侵犯肝动脉或腹腔动脉，手术切除困难。远端胰腺切除术与腹腔轴切除术（DP-CAR）最近已被执行，以实现这些肿瘤的根治性切除。然而，其安全性和有效性仍不清楚。本研究旨在阐明DP-CAR的有效性和安全性，主要关注与新辅助治疗（NAT）的联合应用。方法我们回顾性分析了2010年至2016年期间接受DP-CAR治疗的31例胰腺导管腺癌患者。来自7例接受DP-CAR而不进行NAT的患者的数据被用作参考（前期手术，US）.ResultsGemcitabine + S-1（GS）（n=17）和Gemcitabine +白蛋白结合紫杉醇（GNP）（n=8）经常被用作NAT。NAT组中位生存期（MST）为38.6个月，US组为15.6个月。NAT组的R 0切除率较高（74%），而US组7例中仅1例实现了R 0切除。结论NAT联合DP-CAR治疗侵犯腹腔动脉和/或肝动脉的胰腺体尾癌是安全可行的。应在前瞻性研究中进一步评估该策略的最佳方案和NAT持续时间。
PurposePancreatic body/tail cancer commonly invades the hepatic artery or celiac artery, making surgical resection difficult. Distal pancreatectomy with celiac axis resection (DP-CAR) has recently been performed to achieve curative resection of these tumors. However, the safety and efficacy remain unclear. This study aimed to clarify the efficacy and safety of DP-CAR, mainly focusing on the combination with neoadjuvant therapy (NAT).MethodsWe retrospectively reviewed 31 consecutive patients with pancreatic ductal adenocarcinoma who underwent DP-CAR between 2010 and 2016. Data from 7 patients who underwent DP-CAR without NAT were used as a reference (upfront surgery, US).ResultsGemcitabine + S-1 (GS) (n=17) and gemcitabine + albumin-bound paclitaxel (GnP) (n=8) were frequently used as NAT. DP-CAR following NAT was performed safely with 1 death, resulting in a mortality rate of 3%. The median survival time (MST) in the NAT group was 38.6months, while that in the US group was 15.6months. The NAT group had a high R0 resection rate (74%), while only 1 of 7 cases in the US group achieved R0 resection. Within the NAT group, patients treated with GS showed favorable overall survival with 39.5months of MST, while that of patients treated with GnP was 19.8months.ConclusionThe combination of NAT and DP-CAR was feasible and safe for pancreatic body/tail cancer invading the celiac artery and/or hepatic artery. This strategy should be further assessed for the optimal regimen and duration of NAT in prospective studies.