title: Distal Pancreatectomy with en Bloc Celiac Axis Resection (Modified Appleby Procedure) for Locally Advanced Pancreatic Body Cancer: A Single-Center Review of 80 Consecutive Patients.
abstract: Recently, distal pancreatectomy with en bloc celiac axis resection (DP-CAR) or modified Appleby procedure for locally advanced pancreatic body cancer is increasingly reported. However, actual long-term survival data are still unknown.
  
  
  
  This study retrospectively reviewed 80 consecutive patients with pancreatic body cancer who underwent DP-CAR at a single institution.
  
  
  
  The study included 40 men and 40 women with a median age of 65 years (range, 44-85 years). A pancreatic fistula was the most common complication, occurring in 47 patients (57.5 %). Other complications with a high incidence were ischemic gastropathy (23 patients, 28.8 %) and delayed gastric emptying (20 patients, 25 %). According to the Clavien-Dindo classification, the major complications, defined as complications of grade 3 or higher, were observed in 33 patients (41.3 %), and the in-hospital mortality involved four patients (5 %). For all 80 patients, the 1-, 2-, and 5-year overall survivals (OSs) were respectively 81.1, 56.9, and 32.7 %, and the median survival time was 30.9 months. The actual 5-year survival for the 61 patients whose surgery was performed five or more years earlier was 27.9 % (17 of 61). The 1-, 2-, and 5-year OSs for the patients who underwent preoperative therapy (100, 90, and 78.8 %) were significantly better than for those who underwent upfront surgery (77.9, 51.5, and 26.7 %; P < 0.0001).
  
  
  
  The findings show DP-CAR to be a valid procedure for treating locally advanced pancreatic body cancer, which might contribute more to patients' survival when performed as part of multidisciplinary treatment.
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan. torunakamura@med.hokudai.ac.jp.
authors: Toru
authors: T
authors: Nakamura
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Satoshi
authors: S
authors: Hirano
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Takehiro
authors: T
authors: Noji
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Toshimichi
authors: T
authors: Asano
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Keisuke
authors: K
authors: Okamura
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Takahiro
authors: T
authors: Tsuchikawa
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Soichi
authors: S
authors: Murakami
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yo
authors: Y
authors: Kurashima
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yuma
authors: Y
authors: Ebihara
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yoshitsugu
authors: Y
authors: Nakanishi
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Kimitaka
authors: K
authors: Tanaka
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Toshiaki
authors: T
authors: Shichinohe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents; D000971:Antineoplastic Combined Chemotherapy Protocols; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D002445:Celiac Artery / Q000601:surgery*; D005260:Female; D005746:Gastric Emptying; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000150:complications; D008113:Liver Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D013272:Stomach Diseases / Q000209:etiology / Q000503:physiopathology; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents