15-Year Experience of Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer—A Korean Nationwide Investigation

SIMPLE SUMMARY: Distal pancreatectomy with celiac axis resection (DP-CAR) is a procedure for achieving curative resection in pancreatic body or tail cancer involving celiac axis. The present study aimed to investigate surgical and oncologic outcomes of DP-CAR using a Korean nationwide database. A total of 75 patients who underwent DP-CAR between 2007 and 2021 were included in the study. The major complication rate was 26.7%, with two (2.7%) procedure-related mortalities. There were 10 (13.3%) patients with gastropathy and two (2.7%) patients with hepatic ischemia. The median recurrence-free survival was seven months and the median overall survival was 19 months. In neoadjuvant treatment group (n = 42), the maximal preoperative value of standardized uptake from positron emission tomography was an independent factor for recurrence-free survival. The decrease in carbohydrate antigen 19-9 level predicted prolonged overall survival in patients with neoadjuvant treatment. We identified that DP-CAR could be a potential option for borderline resectable or locally ad-vanced pancreatic cancer in selected patients. ABSTRACT: Background: As systemic treatment for pancreatic cancer advances, distal pancreatectomy with celiac axis resection (DP-CAR) has been considered a curative-intent surgical option for advanced pancreatic cancer. This study aimed to review the surgical and oncologic outcomes of patients undergoing DP-CAR based on Korean nationwide data. Methods: We collected the data of patients who underwent DP-CAR for pancreatic cancer between 2007 and 2021 at seven major hospitals in Korea. The clinicopathological characteristics, postoperative complications, and data on the survival of the patients were retrospectively reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications and survival. Results: A total of 75 patients, consisting mainly of borderline resectable (n = 32) or locally advanced (n = 30) pancreatic cancer, were included in the analysis. Forty-two (56.0%) patients underwent neoadjuvant treatment (NAT). Twenty (26.7%) patients experienced Clavien–Dindo grade ≥ 3 complications, including four patients with ischemic gastropathy, two with hepatic ischemia, and two procedure-related mortalities. Neoadjuvant chemotherapy increased the risk of postoperative complications (p = 0.028). The median recurrence-free and overall survival were 7 and 19 months, with a 5-year survival rate of 13% and 24%, respectively. In the NAT group, a decrease in CA 19-9 and the post-NAT maximum standardized uptake value (SUVmax) in positron emission tomography were associated with survival after surgical resection. Conclusions: Despite the possibility of major complications, DP-CAR could be a feasible option for achieving curative resection with fair survival outcomes in patients with borderline resectable or locally advanced pancreatic cancer. Further studies investigating the safety of the procedure and identifying proper surgical candidates with potential survival gains are necessary.