Addeo P, Guerra M, Bachellier P. Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) and arterial reconstruction: Techniques and outcomes. J Surg Oncol. 2021 Jun;123(7):1592-1598.

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Results: Sixty consecutive DP-CARs were reviewed. Most patients underwent induction chemotherapy (85%) based on FOLFIRINOX protocol (80.3%). The hepatic artery was reconstructed in 50 patients (83.3%). The left gastric artery was reconstructed in 4 and preserved in 14 patients. A venous resection was associated during 44 DP-CARs (36 segmental venous resections/8 lateral venous resections). Ninety days mortality was 5.0% with 48.3% (n = 29) overall rate of morbidity. Postoperative outcomes in term of mortality, morbidity, and ischemic events between patients with and without arterial reconstruction were similar despite a higher rate of venous resection (81% vs. 40%; p = 0.005) and more complex cases (Mayo clinic DP-CARs class 1B, 2A, and 3A) in the reconstructed group.

Conclusion: Arterial reconstruction represents a safe surgical option during DP-CAR to lessen postoperative ischemic events. This technique, reserved to high volume centers expert in vascular resection during pancreatectomy, deserves further comparison with standard technique in a larger setting.

Gong H, et al. Distal Pancreatectomy With En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016 Mar;95(10):e3061. Free full-text.

“Advanced pancreatic body/tail cancer is often considered unresectable because the celiac artery is usually invaded by the time of diagnosis. DP-CAR dramatically increases the tumor respectability because of the complete resection of tumors and involved vessels. Until now, only sporadic retrospective studies of DP-CAR with small samples have been available. We have lacked convincing evidence comparing postoperative outcomes between DP-CAR and standard DP. The advantages and disadvantages of DP-CAR remain unclear. Therefore, a systematic review and meta-analysis comparing DP-CAR to DP was performed; the results indicated that DP-CAR is a complex surgical procedure with high postoperative morbidity but with acceptable postoperative survival and quality of life.”