{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T03:23:50Z","timestamp":1781753030516,"version":"3.54.5"},"reference-count":33,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T00:00:00Z","timestamp":1728691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Distal pancreatectomy with celiac axis resection (DP-CAR) has been used for selected patients with pancreatic cancer infiltrating the celiac axis. We compared the short- and long-term outcomes between DP-CAR and distal pancreatectomy alone (DP) in patients receiving neoadjuvant therapy. Methods: Patients undergoing DP-CAR from 2013 to 2022 were retrospectively reviewed. Clinicopathologic features, post-operative morbidity, and survival outcomes were compared with patients undergoing DP after neoadjuvant chemotherapy. Results: Twenty-two DP-CAR and thirty-four DP patients who underwent neoadjuvant chemotherapy were identified. There were no differences in comorbidities or CA19-9 levels. OR time was longer for DP-CAR (304 vs. 240 min, p = 0.007), but there was no difference in the transfusion rate (22.7% vs. 14.7%). Vascular reconstruction was more common in DP-CAR (18.2% vs. 0% arterial, p = 0.05; 40.9% vs. 12.5% venous, p = 0.04). There was no difference in morbidity or mortality between the two groups. Although there was a trend towards larger tumors in DP-CAR (5.1 cm vs. 3.8 cm, p = 0.057), the overall survival from the initiation of treatment (32 vs. 28 months, p = 0.43) and surgery (30 vs. 24 months, p = 0.43) were similar. Discussion: DP-CAR is associated with similar survival and morbidity compared to DP patients requiring neoadjuvant chemotherapy and should be pursued in appropriately selected patients.<\/jats:p>","DOI":"10.3390\/cancers16203467","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T06:46:33Z","timestamp":1728888393000},"page":"3467","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Distal Pancreatectomy with and without Celiac Axis Resection for Adenocarcinoma: A Comparison in the Era of Neoadjuvant Therapy"],"prefix":"10.3390","volume":"16","author":[{"given":"Sara K.","family":"Daniel","sequence":"first","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille E.","family":"Hironaka","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9797-7106","authenticated-orcid":false,"given":"M. Usman","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Delitto","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Dua","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byrne","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Norton","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan C.","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Poultsides","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1200\/JCO.22.01134","article-title":"Adjuvant nab-Paclitaxel + Gemcitabine in Resected Pancreatic Ductal Adenocarcinoma: Results From a Randomized, Open-Label, Phase III Trial","volume":"41","author":"Tempero","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1001\/jamaoncol.2022.3829","article-title":"Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial","volume":"8","author":"Conroy","year":"2022","journal-title":"JAMA Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.bpg.2005.11.003","article-title":"Venous resection in pancreatic cancer surgery","volume":"20","author":"Tseng","year":"2006","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2648","DOI":"10.1007\/s00268-010-0699-6","article-title":"Vascular reconstruction during pancreatoduodenectomy for ductal adenocarcinoma of the pancreas improves resectability but does not achieve cure","volume":"34","author":"Ouaissi","year":"2010","journal-title":"World J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.21873\/invivo.12793","article-title":"Vascular Resections in Association with Pancreatic Resections for Locally Advanced Pancreatic Cancer","volume":"36","author":"Bacalbasa","year":"2022","journal-title":"In Vivo"},{"key":"ref_7","first-page":"885","article-title":"Resection of advanced pancreatic body-tail carcinoma by Appleby\u2019s operation","volume":"30","author":"Nimura","year":"1976","journal-title":"Shujutu"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1002\/1097-0142(195307)6:4<704::AID-CNCR2820060410>3.0.CO;2-P","article-title":"The coeliac axis in the expansion of the operation for gastric carcinoma","volume":"6","author":"Appleby","year":"1953","journal-title":"Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"109248","DOI":"10.1016\/j.ejrad.2020.109248","article-title":"Perioperative CT angiography assessment of locally advanced distal pancreatic carcinoma to evaluate feasibility of the modified Appleby procedure","volume":"131","author":"Gupta","year":"2020","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2214\/AJR.18.20887","article-title":"Appleby Procedure (Distal Pancreatectomy with Celiac Artery Resection) for Locally Advanced Pancreatic Carcinoma: Indications, Outcomes, and Imaging","volume":"213","author":"Cannella","year":"2019","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.hpb.2016.05.003","article-title":"Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: A single institutional assessment of perioperative outcomes and survival","volume":"18","author":"Ocuin","year":"2016","journal-title":"HPB"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1245\/s10434-016-5493-8","article-title":"Distal Pancreatectomy with en Bloc Celiac Axis Resection (Modified Appleby Procedure) for Locally Advanced Pancreatic Body Cancer: A Single-Center Review of 80 Consecutive Patients","volume":"23","author":"Nakamura","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.pan.2017.11.005","article-title":"Is distal pancreatectomy with en-bloc celiac axis resection effective for patients with locally advanced pancreatic ductal adenocarcinoma? -Multicenter surgical group study","volume":"18","author":"Yamamoto","year":"2018","journal-title":"Pancreatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s00423-018-1692-z","article-title":"Ischemic gastropathy after distal pancreatectomy with en bloc celiac axis resection for pancreatic body cancer","volume":"403","author":"Okada","year":"2018","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1245\/s10434-018-6391-z","article-title":"Outcomes after Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study","volume":"25","author":"Klompmaker","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00423-019-01775-0","article-title":"Feasibility and safety of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) combined with neoadjuvant therapy for borderline resectable and unresectable pancreatic body\/tail cancer","volume":"404","author":"Yoshitomi","year":"2019","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1007\/s11605-019-04324-8","article-title":"Efficacy of Neoadjuvant Chemotherapy in Distal Pancreatectomy with En Bloc Celiac Axis Resection (DP-CAR) for Locally Advanced Pancreatic Cancer","volume":"24","author":"Yoshiya","year":"2020","journal-title":"J. Gastrointest. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s00423-020-01919-7","article-title":"Distal pancreas-coeliac axis resection with preoperative selective embolization of the coeliac axis: A single high-volume centre experience","volume":"405","author":"Storkholm","year":"2020","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jamcollsurg.2020.05.005","article-title":"En Bloc Celiac Axis Resection for Pancreatic Cancer: Classification of Anatomical Variants Based on Tumor Extent","volume":"231","author":"Truty","year":"2020","journal-title":"J. Am. Coll. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1002\/jso.26424","article-title":"Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) and arterial reconstruction: Techniques and outcomes","volume":"123","author":"Addeo","year":"2021","journal-title":"J. Surg. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s12094-020-02423-6","article-title":"Spanish multicenter study of surgical resection of pancreatic tumors infiltrating the celiac axis: Does the type of pancreatectomy affect results?","volume":"23","author":"Ramia","year":"2021","journal-title":"Clin. Transl. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8283","DOI":"10.1245\/s10434-021-10243-3","article-title":"Details and Outcomes of Distal Pancreatectomy with Celiac Axis Resection Preserving the Left Gastric Arterial Flow","volume":"28","author":"Inoue","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/j.pan.2021.01.008","article-title":"Survival impact of distal pancreatectomy with en bloc celiac axis resection combined with neoadjuvant chemotherapy for borderline resectable or locally advanced pancreatic body carcinoma","volume":"21","author":"Murakami","year":"2021","journal-title":"Pancreatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3125","DOI":"10.1245\/s10434-020-09201-2","article-title":"An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)","volume":"28","author":"Schmocker","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.asjsur.2021.03.055","article-title":"Distal pancreatectomy with celiac artery resection acquires satisfactory survival for locally advanced pancreatic neck\/body cancer","volume":"45","author":"Li","year":"2022","journal-title":"Asian J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Egorov, V., Kim, P., Kharazov, A., Dzigasov, S., Popov, P., Rykova, S., Zelter, P., Demidova, A., Kondratiev, E., and Grigorievsky, M. (2022). Hemodynamic, Surgical and Oncological Outcomes of 40 Distal Pancreatectomies with Celiac and Left Gastric Arteries Resection (DP CAR) without Arterial Reconstructions and Preoperative Embolization. Cancers, 14.","DOI":"10.3390\/cancers14051254"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.pan.2021.11.001","article-title":"The role of coeliac axis resection in resected ductal adenocarcinoma of the distal pancreas: A result of tumour topography or a prognostic factor?","volume":"22","author":"Liu","year":"2022","journal-title":"Pancreatology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e1210","DOI":"10.1097\/SLA.0000000000005866","article-title":"Distal Pancreatectomy with En-bloc Celiac Axis Resection (dp-car) for Locally Advanced Pancreatic Cancer: A Safe and Effective Procedure","volume":"278","author":"Loos","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e54","DOI":"10.1097\/MPA.0000000000002218","article-title":"Outcomes of Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer","volume":"52","author":"Shin","year":"2023","journal-title":"Pancreas"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3757","DOI":"10.1245\/s10434-016-5303-3","article-title":"Modified Appleby Procedure for Pancreatic Adenocarcinoma: Does Improved Neoadjuvant Therapy Warrant Such an Aggressive Approach?","volume":"23","author":"Peters","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.1002\/jhbp.184","article-title":"Tips and tricks of the surgical technique for borderline resectable pancreatic cancer: Mesenteric approach and modified distal pancreatectomy with en-bloc celiac axis resection","volume":"22","author":"Hirono","year":"2015","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s12957-019-1667-8","article-title":"Is hepatic artery coil embolization useful in distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer?","volume":"17","author":"Ueda","year":"2019","journal-title":"World J. Surg. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1159\/000265573","article-title":"Postoperative bowel function and nutritional status following distal pancreatectomy with en-bloc celiac axis resection","volume":"27","author":"Hirano","year":"2010","journal-title":"Dig. Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/20\/3467\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:12:22Z","timestamp":1760112742000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/20\/3467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,12]]},"references-count":33,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["cancers16203467"],"URL":"https:\/\/doi.org\/10.3390\/cancers16203467","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,12]]}}}