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Review
. 2021 Apr 19;13(8):1967.
doi: 10.3390/cancers13081967.

Distal Pancreatectomy with Celiac Axis Resection: Systematic Review and Meta-Analysis

Giuseppe Nigri  1 , Niccolò Petrucciani  1 , Elena Belloni  1 , Alessio Lucarini  1 , Paolo Aurello  1 , Francesco D'Angelo  1 , Salomone di Saverio  2 , Alessandro Fancellu  3 , Giovanni Ramacciato  1
Affiliations
Review

Distal Pancreatectomy with Celiac Axis Resection: Systematic Review and Meta-Analysis

Giuseppe Nigri et al. Cancers (Basel). .

Abstract

Background: Major vascular invasion represents one of the most frequent reasons to consider pancreatic adenocarcinomas unresectable, although in the last decades, demolitive surgeries such as distal pancreatectomy with celiac axis resection (DP-CAR) have become a therapeutical option.

Methods: A meta-analysis of studies comparing DP-CAR and standard DP in patients with pancreatic adenocarcinoma was conducted. Moreover, a systematic review of studies analyzing oncological, postoperative and survival outcomes of DP-CAR was conducted.

Results: Twenty-four articles were selected for the systematic review, whereas eleven were selected for the meta-analysis, for a total of 1077 patients. Survival outcomes between the two groups were similar in terms of 1 year overall survival (OS) (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.34 to 1.31, p = 0.24). Patients who received DP-CAR were more likely to have T4 tumors (OR 28.45, 95% CI 10.46 to 77.37, p < 0.00001) and positive margins (R+) (OR 2.28, 95% CI 1.24 to 4.17, p = 0.008). Overall complications (OR, 1.72, 95% CI, 1.15 to 2.58, p = 0.008) were more frequent in the DP-CAR group, whereas rates of pancreatic fistula (OR 1.16, 95% CI 0.81 to 1.65, p = 0.41) were similar.

Conclusions: DP-CAR was not associated with higher mortality compared to standard DP; however, overall morbidity was higher. Celiac axis involvement should no longer be considered a strict contraindication to surgery in patients with locally advanced pancreatic adenocarcinoma. Considering the different baseline tumor characteristics, DP-CAR may need to be compared with palliative therapies instead of standard DP.

Keywords: borderline resectable; pancreatic cancer; vascular reconstruction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Meta-analysis of post-operative outcome; (a) post-operative pancreatic fistula; (b) post-operative morbidity; (c) positive margins; (d) 1-year overall survival.
Figure 2
Figure 2
Meta-analysis of post-operative outcome; (a) post-operative pancreatic fistula; (b) post-operative morbidity; (c) positive margins; (d) 1-year overall survival.
See this image and copyright information in PMC

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