Extended Distal Pancreatectomy for Cancer of the Body and Tail of the Pancreas: Analysis of Early and Late Results

Abstract

Cancer of the body-tail of the pancreas often involves adjacent structures. Thus, surgical treatment may be extended to other organs or vessels in order to achieve radical resection. The aim of this study is to evaluate the safety and efficacy of extended distal pancreatectomy for ductal adenocarcinoma of the body and tail of the pancreas. Between January 2000 and December 2016, 101 patients underwent distal pancreatectomy (DP) for pancreatic cancer: 65 patients underwent standard-DP and 36 extended-DP, including the resection of the partial stomach (n = 12), adrenal gland (n = 7), liver (n = 7), colon (n = 8), celiac axis (n = 6), portal vein (n = 5), jejunum (n = 4) and kidney (n = 4). The two groups were compared in terms of their TNM classification, pathological grade, nodal status, state of resection margins, age, sex and levels of preoperative serum carbohydrate antigen 19-9 (CA 19.9). The morbidity and mortality were not statistically different in the two groups. The two groups disease-free and overall survival rates were significantly influenced by the tumor’s stage, nodal status, pathological features and resection margins. Survival was not influenced by the extent of the surgical resection. However, when patients were stratified according to the type of extended resection, survival was worse in the group of patients undergoing vascular resection. Multivariate analysis showed that the stage and resection margins are independent predictors of disease-free and overall survival. Extended distal pancreatectomy may be performed with acceptable morbidity and mortality rates. Survival is not significantly different after standard or extended resection. However, the rate of tumor recurrence is high, and long-term survival is a rare event, especially in those patients who undergo distal pancreatectomy associated with vascular resection.

Contemporary report of surgical outcomes after single‐stage total pancreatectomy: A 10‐year experience

“…Not surprisingly, the prognosis in patients undergoing SSTP varied based upon the pathology. The patients studied herein undergoing SSTP for ductal adenocarcinoma had a median overall survival (22.7 months) that outperformed contemporaneous cohorts of PDAC patients undergoing pancreaticoduodenectomy ( n = 501, 20.9 months) 35 or distal pancreatectomy 25 ( n = 101, 16 months). Indeed, this encouraging result may be simply due to the favorable characteristics inherent to a highly select cohort of patients but represents data that now seemingly contests the previous unmet theoretical advantages for which this operation was historically proposed 46 : that total pancreatectomy for adenocarcinoma in carefully select patients may offer a survival advantage over less‐than‐total resection.…”

“…The association between the surgical complexity of TP and short-term outcomes is well described, [42][43][44] however as recently shown, appears proceduralrelated as defined by a four-tiered classification system. Based upon Loos and colleagues criteria, 24 (n = 501, 20.9 months) 35 or distal pancreatectomy 25 (n = 101, 16 months). Indeed, this encouraging result may be simply due to the favorable characteristics inherent to a highly select cohort of patients but represents data that now seemingly contests the previous unmet theoretical advantages for which this operation was historically proposed 46 : that total pancreatectomy for adenocarcinoma in carefully select patients may offer a survival advantage over less-than-total resection.…”

“…Interestingly, multicentric PDAC, which is generally regarded as a rare occurrence, was encountered in five such patients (16%) that necessitated a TP. This report is exclusive to SSTP‐only, compared to previously published studies that include completion TP after either index PD or DP; both with equivalent anatomic and functional results but preemptively and technically different procedures that warrant separate consideration 23–26 …”

“…This report is exclusive to SSTP-only, compared to previously published studies that include completion TP after either index PD or DP; both with equivalent anatomic and functional results but preemptively and technically different procedures that warrant separate consideration. [23][24][25][26] Importantly, significant advancements improving postprocedural TP metabolic consequences allow for the further consideration and performance of this operation. This, in part is attributable to modern insulin formulations, long-term glycemic control via insulin pumps and real-time glucose monitors, and treatment of pancreatic exocrine insufficiency.…”