Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic ductal adenocarcinoma in a retrospective monocentric cohort: neoadjuvant treatment and three-axis embolization of the celiac axis are key factors of success.

[BACKGROUND] Distal pancreatectomy with celiac axis resection (DP-CAR) carries severe morbidity and risk of gastric and liver ischemia. We present the results of three axis embolization of celiac axis (CA) before DP-CAR.

[METHODS] A prospectively maintained single-institution database was queried for patients operated on for potentially resectable locally advanced pancreatic cancer (LAPC) invading the CA.

[RESULTS] From 2008 to 2023, DP-CAR was considered in 27 patients with distal LAPC. All 27 patients had received neoadjuvant treatment (NAT), including 7 who had no resection because of tumor progression and 20 patients who had DP-CAR; 19 had pre-operative three-axis embolization after laparoscopic exploration (LE), and one patient needed arterial reconstruction. There was one death from hepatic ischemia, but no patients had gastric ischemia, with 7 of patients suffering from 90-day severe morbidity. R0 resection was achieved in 16 patients and 13 patients received adjuvant chemotherapy. With 74 months of median follow-up, median disease-free survival was 36 months. Median overall survival was 52 for patients who underwent DP-CAR.

[CONCLUSIONS] DP-CAR for LAPC is associated with high morbidity. However, NAT and LE may prevent unnecessary surgery for patients with progressive disease. Three-axis embolization of CA may prevent ischemic complications.