Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000–2016) and three very-high-volume international centers in the United States and Japan (model validation 2004–2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2–11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9–30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15–25 months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.

Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis / Klompmaker, S.; Peters, N. A.; van Hilst, J.; Bassi, C.; Boggi, U.; Busch, O. R.; Niesen, W.; Van Gulik, T. M.; Javed, A. A.; Kleeff, J.; Kawai, M.; Lesurtel, M.; Lombardo, C.; Moser, A. J.; Okada, K. -I.; Popescu, I.; Prasad, R.; Salvia, R.; Sauvanet, A.; Sturesson, C.; Weiss, M. J.; Zeh, H. J.; Zureikat, A. H.; Yamaue, H.; Wolfgang, C. L.; Hogg, M. E.; Besselink, M. G.; Gerritsen, S. L.; Adham, M.; Albiol Quer, M. T.; Berrevoet, F.; Cesaretti, M.; Dalla Valle, R.; Darnis, B.; Diener, M. K.; Del Chiaro, M.; Hackert, T. H.; Grutzmann, R.; Dumitrascu, T.; Friess, H.; Hirono, S.; Ivanecz, A.; Karayiannakis, A.; Fusai, G. K.; Labori, K. J.; Lopez-Ben, S.; Mabrut, J. -Y.; Miyazawa, M.; Niesen, W.; Pardo, F.; Perinel, J.; Roeyen, G.. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - 26:3(2019), pp. 772-781. [10.1245/s10434-018-07101-0]

Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis

Dalla Valle R.;
2019

Abstract

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000–2016) and three very-high-volume international centers in the United States and Japan (model validation 2004–2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2–11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9–30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15–25 months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.
Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis / Klompmaker, S.; Peters, N. A.; van Hilst, J.; Bassi, C.; Boggi, U.; Busch, O. R.; Niesen, W.; Van Gulik, T. M.; Javed, A. A.; Kleeff, J.; Kawai, M.; Lesurtel, M.; Lombardo, C.; Moser, A. J.; Okada, K. -I.; Popescu, I.; Prasad, R.; Salvia, R.; Sauvanet, A.; Sturesson, C.; Weiss, M. J.; Zeh, H. J.; Zureikat, A. H.; Yamaue, H.; Wolfgang, C. L.; Hogg, M. E.; Besselink, M. G.; Gerritsen, S. L.; Adham, M.; Albiol Quer, M. T.; Berrevoet, F.; Cesaretti, M.; Dalla Valle, R.; Darnis, B.; Diener, M. K.; Del Chiaro, M.; Hackert, T. H.; Grutzmann, R.; Dumitrascu, T.; Friess, H.; Hirono, S.; Ivanecz, A.; Karayiannakis, A.; Fusai, G. K.; Labori, K. J.; Lopez-Ben, S.; Mabrut, J. -Y.; Miyazawa, M.; Niesen, W.; Pardo, F.; Perinel, J.; Roeyen, G.. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - 26:3(2019), pp. 772-781. [10.1245/s10434-018-07101-0]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2881315
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