Detailed Abstract
[BP Poster Presentation 8 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP PP 8-5] Laparoscopic and open distal pancreatectomy with celiac axis resection for borderline resectable or locally advanced pancreatic cancers: Perioperative outcomes and survival assessment
Hyeyeon KIM1 , Ki Byung SONG*1
1 Division Of Hepatobiliary And Pancreatic Surgery, Department Of Surgery, Asan Medical Center, REPUBLIC OF KOREA
Background : Distal pancreatectomy with celiac axis resection (DP-CAR) is remarkable option for borderline resectable or locally advanced pancreatic body cancers. Laparoscopic procedures have emerged recently, though its effectiveness on DP-CAR remains unclear. The purpose of this study is to compare surgical outcomes and survivals of open DP-CAR (ODP-CAR) and laparoscopic DP-CAR (LDP-CAR), and to determine the safety and feasibility of LDP-CAR upon ODP-CAR.
Methods : Retrospectively analyzed all consecutive DP-CARs performed in Asan Medical Center from the beginning till December 2020. Baseline characteristics, perioperative and oncologic outcomes, long-term survivals were included.
Results : Sixty-five DP-CARs were performed (55 open, 10 laparoscopic) during study period. No significant differences showed in baseline characteristics. LDP-CAR was associated with shorter operative time (311.3?14.7 vs. 221.5?1.2 min, p=0.021), and lower intraoperative transfusion rate (41.8 vs. 10.0%, p=0.078). Combined other organ resection rate was higher in ODP-CAR, especially in portal vein resection (34.5 vs. 0.0%, p<0.001). Major complication rate was higher in ODP-CAR (36.4 vs. 0.0%, p=0.019), but no significant differences were shown in postoperative pancreatic fistula, 90-day mortality, readmission, reoperation, and R0 resection rates. At median overall follow-up of 23.8 months, no significant differences were shown between two groups both in overall survival rate (24.2?9.3 vs. 29.4?3.2 months, p=0.449) and disease-free survival rate (14.4?6.6 vs. 16.2?8.2 months, p=0.761). Notably, celiac trunk length in preoperative CT scan was significantly longer in LDP-CAR (8.3?.7 vs. 21.4?.6cm, p<0.001).
Conclusions : LDP-CAR represents shorter operative time and lower transfusion rate than ODP-CAR, though showed higher major complication rates with similar overall and disease-free survival rates. LDP-CAR could be an acceptable alternative to the open technique in carefully selected pancreatic cancer patients, borderline resectable or locally advanced cases.
Methods : Retrospectively analyzed all consecutive DP-CARs performed in Asan Medical Center from the beginning till December 2020. Baseline characteristics, perioperative and oncologic outcomes, long-term survivals were included.
Results : Sixty-five DP-CARs were performed (55 open, 10 laparoscopic) during study period. No significant differences showed in baseline characteristics. LDP-CAR was associated with shorter operative time (311.3?14.7 vs. 221.5?1.2 min, p=0.021), and lower intraoperative transfusion rate (41.8 vs. 10.0%, p=0.078). Combined other organ resection rate was higher in ODP-CAR, especially in portal vein resection (34.5 vs. 0.0%, p<0.001). Major complication rate was higher in ODP-CAR (36.4 vs. 0.0%, p=0.019), but no significant differences were shown in postoperative pancreatic fistula, 90-day mortality, readmission, reoperation, and R0 resection rates. At median overall follow-up of 23.8 months, no significant differences were shown between two groups both in overall survival rate (24.2?9.3 vs. 29.4?3.2 months, p=0.449) and disease-free survival rate (14.4?6.6 vs. 16.2?8.2 months, p=0.761). Notably, celiac trunk length in preoperative CT scan was significantly longer in LDP-CAR (8.3?.7 vs. 21.4?.6cm, p<0.001).
Conclusions : LDP-CAR represents shorter operative time and lower transfusion rate than ODP-CAR, though showed higher major complication rates with similar overall and disease-free survival rates. LDP-CAR could be an acceptable alternative to the open technique in carefully selected pancreatic cancer patients, borderline resectable or locally advanced cases.
SESSION
BP Poster Presentation 8
Poster Presentation 3/4/2022 3:20 PM - 4:20 PM