• Martin Loos, Elias Khajeh, Arianeb Mehrabi, Benedict Kinny-Köster, Mohammed Al-Saeedi, Christoph Berchtold, Katrin Hoffmann, Martin Schneider, Pegah Eslami, Manuel Feisst, Ulf Hinz, Thilo Hackert, and Markus W Büchler.
• Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
• Ann. Surg. 2023 Dec 1; 278 (6): e1210e1215e1210-e1215.

ObjectiveTo determine perioperative and oncologic outcomes after distal pancreatectomy with en bloc resection of the celiac axis (DP-CAR).BackgroundDP-CAR can be used in a selective group of patients to resect locally advanced pancreatic cancer involving the celiac axis or common hepatic artery without arterial reconstruction by preserving retrograde blood flow via the gastroduodenal artery to the liver and stomach.MethodsWe analyzed all consecutive patients who had undergone DP-CAR between May 2003 and April 2022 at a tertiary hospital specialized in pancreatic surgery and present one of the largest single-center studies.ResultsA total of 71 patients underwent DP-CAR. Additional venous resection (VR) of the mesenterico-portal axis was performed in 31 patients (44%) and multivisceral resection (MVR) in 42 patients (59%). Margin-free (R0) resection was achieved in 40 patients (56%). The overall 90-day mortality rate was 8.4% for the entire patient cohort. After a cumulated experience of 16 cases, the 90-day mortality dropped to 3.6% in the following 55 patients. Extended procedures with (+) additional MVR with or without (+/-) VR resulted in higher major morbidity (Clavien-Dindo ≥IIIB; standard DP-CAR: 19%; DP-CAR + MVR +/- VR: 36%) and higher 90-day mortality (standard DP-CAR: 0%; DP-CAR + MVR +/- VR: 11%). Median overall survival after DP-CAR was 28 months.ConclusionsDP-CAR is a safe and effective procedure but requires experience. Frequently, surgical resection has to be extended with MVR and VR to accomplish tumor resection, which results in promising oncologic outcomes. However, extended resections were associated with increased morbidity and mortality.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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