Thibaud Bertrand, Safi Dokmak, Béatrice Aussilhou, Louis de Mestier, Olivia Hentic, Jérome Cros, Vinciane Rebours, Maxime Ronot, Mickael Lesurtel, Alain Sauvanet
{"title":"在一项回顾性单中心队列研究中，远端胰腺切除术联合腹腔轴切除术（DP-CAR）治疗胰管腺癌：新辅助治疗和腹腔轴三轴栓塞是成功的关键因素。","authors":"Thibaud Bertrand, Safi Dokmak, Béatrice Aussilhou, Louis de Mestier, Olivia Hentic, Jérome Cros, Vinciane Rebours, Maxime Ronot, Mickael Lesurtel, Alain Sauvanet","doi":"10.1016/j.hpb.2025.04.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Distal pancreatectomy with celiac axis resection (DP-CAR) carries severe morbidity and risk of gastric and liver ischemia. We present the results of three axis embolization of celiac axis (CA) before DP-CAR.</p><p><strong>Methods: </strong>A prospectively maintained single-institution database was queried for patients operated on for potentially resectable locally advanced pancreatic cancer (LAPC) invading the CA.</p><p><strong>Results: </strong>From 2008 to 2023, DP-CAR was considered in 27 patients with distal LAPC. All 27 patients had received neoadjuvant treatment (NAT), including 7 who had no resection because of tumor progression and 20 patients who had DP-CAR; 19 had pre-operative three-axis embolization after laparoscopic exploration (LE), and one patient needed arterial reconstruction. There was one death from hepatic ischemia, but no patients had gastric ischemia, with 7 of patients suffering from 90-day severe morbidity. R0 resection was achieved in 16 patients and 13 patients received adjuvant chemotherapy. With 74 months of median follow-up, median disease-free survival was 36 months. Median overall survival was 52 for patients who underwent DP-CAR.</p><p><strong>Conclusions: </strong>DP-CAR for LAPC is associated with high morbidity. However, NAT and LE may prevent unnecessary surgery for patients with progressive disease. Three-axis embolization of CA may prevent ischemic complications.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic ductal adenocarcinoma in a retrospective monocentric cohort: neoadjuvant treatment and three-axis embolization of the celiac axis are key factors of success.\",\"authors\":\"Thibaud Bertrand, Safi Dokmak, Béatrice Aussilhou, Louis de Mestier, Olivia Hentic, Jérome Cros, Vinciane Rebours, Maxime Ronot, Mickael Lesurtel, Alain Sauvanet\",\"doi\":\"10.1016/j.hpb.2025.04.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Distal pancreatectomy with celiac axis resection (DP-CAR) carries severe morbidity and risk of gastric and liver ischemia. We present the results of three axis embolization of celiac axis (CA) before DP-CAR.</p><p><strong>Methods: </strong>A prospectively maintained single-institution database was queried for patients operated on for potentially resectable locally advanced pancreatic cancer (LAPC) invading the CA.</p><p><strong>Results: </strong>From 2008 to 2023, DP-CAR was considered in 27 patients with distal LAPC. All 27 patients had received neoadjuvant treatment (NAT), including 7 who had no resection because of tumor progression and 20 patients who had DP-CAR; 19 had pre-operative three-axis embolization after laparoscopic exploration (LE), and one patient needed arterial reconstruction. There was one death from hepatic ischemia, but no patients had gastric ischemia, with 7 of patients suffering from 90-day severe morbidity. R0 resection was achieved in 16 patients and 13 patients received adjuvant chemotherapy. With 74 months of median follow-up, median disease-free survival was 36 months. Median overall survival was 52 for patients who underwent DP-CAR.</p><p><strong>Conclusions: </strong>DP-CAR for LAPC is associated with high morbidity. However, NAT and LE may prevent unnecessary surgery for patients with progressive disease. Three-axis embolization of CA may prevent ischemic complications.</p>\",\"PeriodicalId\":13229,\"journal\":{\"name\":\"Hpb\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-04-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hpb\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hpb.2025.04.009\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hpb","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hpb.2025.04.009","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic ductal adenocarcinoma in a retrospective monocentric cohort: neoadjuvant treatment and three-axis embolization of the celiac axis are key factors of success.
Background: Distal pancreatectomy with celiac axis resection (DP-CAR) carries severe morbidity and risk of gastric and liver ischemia. We present the results of three axis embolization of celiac axis (CA) before DP-CAR.
Methods: A prospectively maintained single-institution database was queried for patients operated on for potentially resectable locally advanced pancreatic cancer (LAPC) invading the CA.
Results: From 2008 to 2023, DP-CAR was considered in 27 patients with distal LAPC. All 27 patients had received neoadjuvant treatment (NAT), including 7 who had no resection because of tumor progression and 20 patients who had DP-CAR; 19 had pre-operative three-axis embolization after laparoscopic exploration (LE), and one patient needed arterial reconstruction. There was one death from hepatic ischemia, but no patients had gastric ischemia, with 7 of patients suffering from 90-day severe morbidity. R0 resection was achieved in 16 patients and 13 patients received adjuvant chemotherapy. With 74 months of median follow-up, median disease-free survival was 36 months. Median overall survival was 52 for patients who underwent DP-CAR.
Conclusions: DP-CAR for LAPC is associated with high morbidity. However, NAT and LE may prevent unnecessary surgery for patients with progressive disease. Three-axis embolization of CA may prevent ischemic complications.
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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