ASO Author Reflections: Lymphadenectomy in Distal Pancreatectomy for Ductal Adenocarcinoma: How to Do Better?

Abstract Background and Aims Endoscopic ultrasonography-guided ethanol lavage and Taxol injection (EUS-ELTI) in pancreatic cystic lesions have been recently performed in some medical centers. This study aimed to optimize the patient selection and analyze the outcomes in patients who underwent surgery after EUS-ELTI in pancreatic cystic lesions. Methods Among 310 patients who underwent EUS-ELTI between January 2007 and December 2014, 23 underwent surgery after EUS-ELTI owing to incomplete treatment and/or adverse events. We evaluated the surgical outcomes in patients who underwent surgery after EUS-ELTI. Then, we retrospectively compared the clinical outcomes of the patients who underwent the surgery after EUS-ELTI with those of patients who underwent upfront surgery for left-sided pancreatic lesions without the EUS-ELTI procedure. Results The pathology revealed degenerated cysts in 12 patients, mucinous cyst neoplasms in five patients, neuroendocrine tumors in two patients, and one intraductal papillary mucinous neoplasm (IPMN), one solid pseudopapillary tumor, one pancreatic ductal adenocarcinoma arising from an IPMN, and one hepatoid carcinoma. Twelve patients underwent laparoscopic distal pancreatectomy and five patients underwent open distal pancreatectomy. All six patients who had lesions in the pancreatic head underwent open pancreaticoduodenectomy. When we retrospectively compared the clinical outcomes between patients who underwent laparoscopic distal pancreatectomy after EUS-ELTI and those who did not receive the EUS-ELTI procedure, the spleen-preserving rate was 0% in the EUS-ELTI group and 61.7% (365/592) in the non-EUS-ELTI group (P < 0.001). Clinically relevant postoperative pancreatic fistulas occurred in 33.3% of patients in the EUS-ELTI group and in 6.8% of patients in the non-EUS-ELTI group (P = 0.025). The mean postoperative hospital stay was also shorter in the non-EUS-ELTI group than in the EUS-ELTI group (8.66 ± 5.66 and 13.56 ± 7.20, P = 0.032). Conclusion Surgical outcomes are compromised after EUS-ELTI in the cystic tumor of the pancreas. Further investigations are needed for investigation of the efficacy and safety of the EUS-ELTI procedure.

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Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study

HPB ◽

10.1016/j.hpb.2019.10.609 ◽

2019 ◽

Vol 21 ◽

pp. S714

Author(s):

J. van Hilst ◽

T. de Rooij ◽

S. Klompmaker ◽

M. Rawashdeh ◽

F. Aleotti ◽

...

Keyword(s):

Propensity Score ◽

Minimally Invasive ◽

Distal Pancreatectomy ◽

Ductal Adenocarcinoma ◽

Open Distal Pancreatectomy ◽

Matched Study

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Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA)—a difficult question to answer

Laparoscopic Surgery ◽

10.21037/ls.2018.01.02 ◽

2018 ◽

Vol 2 ◽

pp. 2-2

Author(s):

Jonathan Ghing-Chi Sham ◽

Michele Maiko Gage ◽

Jin He

Keyword(s):

Minimally Invasive ◽

Distal Pancreatectomy ◽

Ductal Adenocarcinoma ◽

Difficult Question ◽

Open Distal Pancreatectomy

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Laparoscopic extended versus open extended distal pancreatectomy for ductal adenocarcinoma: A pan-European propensity-score matched study

HPB ◽

10.1016/j.hpb.2020.04.351 ◽

2020 ◽

Vol 22 ◽

pp. S345-S346

Author(s):

A. Balduzzi ◽

J. Van Hilst ◽

M. Korrel ◽

S. Lof ◽

B. Al-Sarireh ◽

...

Keyword(s):

Propensity Score ◽

Distal Pancreatectomy ◽

Ductal Adenocarcinoma ◽

Matched Study

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Is safe the laparoscopic approach in distal pancreatectomy for ductal adenocarcinoma? Systematic review and meta-analysis

Pancreatology ◽

10.1016/j.pan.2015.05.163 ◽

2015 ◽

Vol 15 (3) ◽

pp. S38-S39

Author(s):

Giovanni Taffurelli ◽

Claudio Ricci ◽

Carlo Alberto Pacilio ◽

Carlo Ingaldi ◽

Selene Bogoni ◽

...

Keyword(s):

Systematic Review ◽

Distal Pancreatectomy ◽

Meta Analysis ◽

Laparoscopic Approach ◽

Ductal Adenocarcinoma

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Is rising BMI associated with an increased rate of clinically relevant pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma?

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.360 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 360-360

Author(s):

Evan Scott Glazer ◽

Yixuan Zhou ◽

Justin Drake ◽

Jeremiah Lee Deneve ◽

Stephen W Behrman ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Logistic Regression Analysis ◽

Older Age ◽

Ductal Adenocarcinoma ◽

Multivariable Logistic Regression Analysis ◽

Term Survival ◽

Increased Risk

360 Background: Clinically relevant pancreatic fistula (CR-POPF), following distal pancreatectomy (DP) remains a clinical challenge. Prior studies investigating the relationship between body mass index (BMI) and CR-POPF have yielded conflicting results. We examined this relationship utilizing our institutional database and hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who underwent DP for PDAC at a single institution from 2007 to 2018 were retrospectively reviewed. A CR-POPF was defined as ISGPS grade B or C fistula. Uni- and multi-variable logistic regression analysis to assess factors associated with CR-POPF following DP was performed, controlling for factors such as gland texture, operative drain placement, gender, and smoking status. Results: 78 patients met the inclusion criteria. 51% were female, 51% were Caucasian, and the average age was 59 ± 15 years. The median BMI was 26 (interquartile range 24 to 29). Overall, 19% (n = 15) of patients had a CR-POPF. With a mean follow up 2.8 ± 2.5 years, the presence of a CR-POPF was not associated with long-term survival (P = 0.17). On univariable logistic regression, older age was associated with a decreased risk of CR-POPF (OR = 0.95, P = 0.015) while increasing BMI was associated with an increased risk of CR-POPF (OR = 1.1, P = 0.044). After controlling for multiple factors on multivariable logistic regression analysis, BMI (OR = 1.12, P = 0.035) was the only factor associated with development of a CR-POPF while older age (OR = 0.94, P < 0.001) was slightly protective of CR-POPF development. Conclusions: For patients undergoing DP for PDAC, increasing BMI is associated with an increased risk of CR-POPF, independent of other factors. These findings should be considered during preoperative counseling. Although there is no specific cut-off for the association between BMI and CR-POPF, efforts to diminish the risk of CR-POPF should be focused on patients with higher BMI based on this data.

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