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

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 (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 26

Journal Issue: 3

DOI: 10.1245/s10434-018-07101-0

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.

Authors with CRIS profile

Involved external institutions

Karolinska Institute Sweden (SE) Ruprecht-Karls-Universität Heidelberg Germany (DE) University of Verona / Università degli Studi di Verona Italy (IT) University of Texas Southwestern Medical Center (UT Southwestern) United States (USA) (US) Wakayama Medical University Japan (JP) Johns Hopkins Hospital United States (USA) (US) Hospices Civils de Lyon (CHU) France (FR) University of Pittsburgh United States (USA) (US) Royal Free Hospital United Kingdom (GB) NHS Blood and Transplant (NHSBT) United Kingdom (GB) Antwerp University Hospital Belgium (BE) Hospital Universitari Dr. Josep Trueta Spain (ES) University of Parma / Università degli Studi di Parma Italy (IT) University of Amsterdam Netherlands (NL) University of Colorado System United States (USA) (US) Beaujon Hospital / Hôpital Beaujon France (FR) University of Pisa / Università di Pisa (UniPi) Italy (IT) Spitalul Clinic Fundeni Bucuresti Romania (RO) University Hospital Ghent Belgium (BE) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet Norway (NO) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Democritus University of Thrace (DUTH) / Δημοκρίτειο Πανεπιστήμιο Θράκης Greece (GR) Maribor University Medical Centre (Maribor UMC) / Univerzitetni klinični center Maribor Slovenia (SI) Technische Universität München (TUM) Germany (DE) Harvard University United States (USA) (US) Université Claude Bernard Lyon 1 (UCB) France (FR) University of Paris 7 - Denis Diderot / Université Paris VII Denis Diderot France (FR) Clínica Universidad de Navarra Spain (ES) NorthShore University HealthSystem United States (USA) (US)

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://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).

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