title: Distal pancreatectomy with celiac axis resection: what are the added risks?
abstract: BACKGROUND
  Reported series of a distal pancreatectomy with celiac axis resection (DP-CAR) are either small or not adequately controlled. The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative risk.
  
  
  METHODS
  Data were gathered through the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Pancreatectomy Demonstration Project. Over 14 months, 822 patients underwent a distal pancreatectomy at 43 institutions. Twenty of these patients (2.4%) also underwent a celiac axis resection. DP-CAR patients were matched by age, gender, BMI, serum albumin, ASA class, gland texture, duct size and pathology to 172 patients undergoing DP alone.
  
  
  RESULTS
  The majority of DP and DP-CAR patients had adenocarcinomas (61% and 60%). The median operative time for a DP alone was shorter than for a DP-CAR (207 versus 276 min, P < 0.01). Post-operative acute kidney injury (1% versus 10%, P < 0.03) and 30-day mortality were higher after a DP-CAR (1% versus 10%, P < 0.03).
  
  
  CONCLUSIONS
  A distal pancreatectomy with celiac axis resection is associated with increased operative time, post-operative acute kidney injury and a 10% operative mortality. The decision to offer a modified Appleby procedure for a body of pancreas tumour should be made with full disclosure of the increased risks.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Joal D
authors.initials: JD
authors.lastname: Beane
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Pitt
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: E Molly
authors.initials: EM
authors.lastname: Kilbane
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.affiliation: University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Abishek D
authors.initials: AD
authors.lastname: Parmar
authors.affiliation: University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002447:Celiac Plexus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology