• Sjors Klompmaker, Jony van Hilst, Sarah L Gerritsen, Mustapha Adham, M Teresa Albiol Quer, Claudio Bassi, Frederik Berrevoet, Ugo Boggi, Olivier R Busch, Manuela Cesaretti, Raffaele Dalla Valle, Benjamin Darnis, Matteo De Pastena, Marco Del Chiaro, Robert Grützmann, Markus K Diener, Traian Dumitrascu, Helmut Friess, Arpad Ivanecz, Anastasios Karayiannakis, Giuseppe K Fusai, Knut J Labori, Carlo Lombardo, Santiago López-Ben, Jean-Yves Mabrut, Willem Niesen, Fernando Pardo, Julie Perinel, Irinel Popescu, Geert Roeyen, Alain Sauvanet, Raj Prasad, Christian Sturesson, Mickael Lesurtel, Jorg Kleeff, Roberto Salvia, Marc G Besselink, and E-AHPBA DP-CAR study group.
• Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.
• Ann. Surg. Oncol. 2018 May 1; 25 (5): 1440-1447.

BackgroundWestern multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE).MethodsRetrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C).ResultsWe included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10-37). We observed no impact of PHAE on ischemic complications.ConclusionsDP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes.

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