Preoperative hepatic artery embolization before distal pancreatectomy plus celiac axis resection does not improve surgical results: A Spanish multicentre study.

Autor: Ramia JM; Department of Surgery, Hospital General Universitario de Alicante and ISABIAL, Alicante, Spain. Electronic address: jose_ramia@hotmail.com., de Vicente E; Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain., Pardo F; Department of Surgery, Clínica Universitaria de Navarra, Pamplona, Spain., Sabater L; Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute, Valencia, Spain., Lopez-Ben S; Department of Surgery, Hospital Josep Trueta, Girona, Spain., Quijano M Y; Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain., Villegas T; Department of Surgery, Hospital Virgen de las Nieves, Granada, Spain., Blanco-Fernandez G; Department of Surgery, Complejo Hospitalario de Badajoz, Badajoz, Spain., Diez-Valladares L; Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain., Lopez-Rojo I; Fundacion Jimenez Diaz, Madrid, Spain., Martin-Perez E; Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain., Pereira F; Department of Surgery, Hospital Univ, de Fuenlabrada, Fuenlabrada, Spain., Gonzalez AJ; Department of Surgery, Hospital Quirón Málaga, Malaga, Spain., Herrera J; Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain., García-Domingo MI; Department of Surgery, Hospital Mutua de Terrassa, Terrassa, Spain., Serradilla-Martín M; Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitari Miguel Servet, Zaragoza, Spain.
Jazyk: angličtina
Zdroj: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland [Surgeon] 2021 Oct; Vol. 19 (5), pp. e117-e124. Date of Electronic Publication: 2020 Oct 03.
DOI: 10.1016/j.surge.2020.08.012
Abstrakt: Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a surgical procedure with high morbidity and mortality performed in patients with locally advanced pancreatic cancer. Preoperative embolization of hepatic artery (PHAE) has been postulated as a technical option to increase resection rate.
Objective: comparison of morbidity and mortality at 90 days, operative time, hospital stay and survival between patients that performed DP-CAR with and without PHAE.
Methods: Observational retrospective multicentre study.
Inclusion Criteria: patient operated in Spanish centers with DP-CAR for pancreatic cancer from April 2004 until 23 June 2018. Preoperative (PHAE, neodjuvant treatment), intraoperative (operative time and blood loss) and postoperative data (morbidity, hospital stay, R0 and survival) were studied. Complications were measured with Clavien classification at 90 days. Specific pancreatic complications were measured using ISGPS classifications. Data were analyzed using R version 3.1.3 (http://www.r-project.org). Level of significance was set at 0.05.
Results: 41 patients were studied. 26 patients were not embolized (NO-PHAE group) and 15 patients received PHAE. Preoperative BMI and percentage of neoadjuvant chemotherapy were the only preoperative variables different between both groups. The operative time in the PHAE group was shorter (343 min) than in the non-PHAE group (411 min) (p < 0.06). Major morbidity (Clavien > IIIa) and mortality at 90 days were higher in the PHAE group than in the non-PHAE group (60% vs 23% and 26.6% vs 11.6% respectively) (p < 0.004). No statistical difference in overall survival was observed between both groups (p = 0.14).
Conclusion: In our study PHAE is not related with less postoperative morbidity. Even more, major morbidity (Clavien III-IV) and mortality was higher in PHAE group.
Competing Interests: Declaration of Competing Interest No disclosure.
(Copyright © 2020 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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