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

Journal article


Publication Details

Author(s): Klompmaker S, Peters NA, Van Hilst J, Bassi C, Boggi U, Busch OR, Niesen W, Van Gulik TM, Javed AA, Kleeff J, Kawai M, Lesurtel M, Lombardo C, Moser AJ, Okada KI, Popescu I, Prasad R, Salvia R, Sauvanet A, Sturesson C, Weiss MJ, Zeh HJ, Zureikat AH, Yamaue H, Wolfgang CL, Hogg ME, Besselink MG, Gerritsen SL, Adham M, Teresa Albiol M, Berrevoet F, Cesaretti M, Dalla Valle R, Darnis B, Diener MK, Del Chiaro M, Hackert TH, Grützmann R, Dumitrascu T, Friess H, Hirono S, Ivanecz A, Karayiannakis A, Fusai GK, Labori KJ, Lopez-Ben S, Mabrut JY, Miyazawa M, Pardo F, Perinel J, Roeyen G
Journal: Annals of Surgical Oncology
Publication year: 2019
Volume: 26
Journal issue: 3
ISSN: 1068-9265


Abstract

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.


FAU Authors / FAU Editors

Grützmann, Robert Prof. Dr.
Chirurgische Klinik


External institutions with authors

Antwerp University Hospital
Beaujon Hospital / Hôpital Beaujon
Clínica Universidad de Navarra
Democritus University of Thrace (DUTH) / Δημοκρίτειο Πανεπιστήμιο Θράκης
Harvard University
Hospices Civils de Lyon (CHU)
Hospital Universitari Dr. Josep Trueta
Johns Hopkins Hospital
Karolinska Institute
Maribor University Medical Centre (Maribor UMC)
Martin-Luther-Universität Halle-Wittenberg (MLU)
NHS Blood and Transplant (NHSBT)
NorthShore University HealthSystem
Oslo University Hospital / Oslo Universitetssykehus
Royal Free Hospital
Ruprecht-Karls-Universität Heidelberg
Spitalul Clinic Fundeni Bucuresti
Technische Universität München (TUM)
Université Claude Bernard Lyon 1 (UCB)
University Hospital Ghent
University of Amsterdam
University of Colorado System
University of Paris 7 - Denis Diderot / Université Paris VII Denis Diderot
University of Parma / Università degli Studi di Parma
University of Pisa / Università di Pisa (UniPi)
University of Pittsburgh
University of Texas Southwestern Medical Center (UT Southwestern)
University of Verona / Università degli Studi di Verona
Wakayama Medical University


How to cite

APA:
Klompmaker, S., Peters, N.A., Van Hilst, J., Bassi, C., Boggi, U., Busch, O.R.,... Roeyen, G. (2019). Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis. Annals of Surgical Oncology, 26(3). https://dx.doi.org/10.1245/s10434-018-07101-0

MLA:
Klompmaker, Sjors, et al. "Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis." Annals of Surgical Oncology 26.3 (2019).

BibTeX: 

Last updated on 2019-29-03 at 07:38