title: Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic adenocarcinoma following neoadjuvant therapy.
abstract: BACKGROUND
  Celiac trunk encasement by adenocarcinoma of the pancreatic body is generally regarded as a contraindication for surgical resection. Recent studies have suggested that a subset of stage III patients will succumb to their disease in the absence of distant metastases. We hypothesized that patients with stage III tumors invading the celiac trunk, who are free of distant disease following neoadjuvant therapy, may derive prolonged survival benefit from aggressive surgical resection.
  
  
  METHODS
  We performed a retrospective review of distal pancreatectomies with en bloc celiac axis resection for pancreatic adenocarcinoma.
  
  
  RESULTS
  Eleven patients underwent a distal pancreatectomy with en bloc celiac axis resection after completing neoadjuvant chemoradiation therapy. Median operative time was 8 h, 14 min, and median estimated blood loss was 700 ml. Median length of stay was 9 days. Five patients (45%) had postoperative complications; three were Clavien grade I. Four patients (35%) had pancreatic leaks; two were ISGPF grade B, and two were grade A. There were two 90-day perioperative deaths. Ten patients had R0 resections (91%). After a median follow-up of 41 weeks, six patients recurred. Four of the five patients with SMAD4 loss recurred, and two of the five patients with intact SMAD4 recurred. Median disease-free and overall survival were 21 weeks and 26 months, respectively.
  
  
  CONCLUSIONS
  Resection of pancreatic body adenocarcinoma with celiac axis resection is technically feasible with acceptable perioperative morbidity and mortality.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, PA 15232, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Baumgartner
authors.forename: Alyssa
authors.initials: A
authors.lastname: Krasinskas
authors.forename: Mustapha
authors.initials: M
authors.lastname: Daouadi
authors.forename: Amer
authors.initials: A
authors.lastname: Zureikat
authors.forename: Wallis
authors.initials: W
authors.lastname: Marsh
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Bartlett
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D002445:Celiac Artery / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000401:mortality / Q000628:therapy*; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014656:Vascular Surgical Procedures / Q000379:methods*