Distal pancreatectomy with en bloc celiac axis resection does not improve the R0 rate or median survival time of patients with locally advanced pancreatic cancer: a systematic review and meta-analysis

Background: Pancreatic cancer frequently results in celiac artery invasion, resulting in an unresectable disease that generally has a median survival period of 6-11 months. Efforts to achieve curative resection of such tumors have been made by conducting distal pancreatectomy with en bloc celiac axis resection (DP-CAR) in some patients, but the long-term outcome data associated with this approach or its overall value remain to be clarified. Methods: This meta-analysis was conducted to systematically assess the clinical efficacy of the DP-CAR treatment of unresectable tumors of the pancreatic body or tail (registered with PROSPERO: CRD42019129612). The PubMed, EMBASE, the Cochrane Library, and Web of Science databases were searched to identify relevant retrospective studies pertaining to such treatment. Results: Overall, 12 retrospective cohort analyses incorporating 213 total DP-CAR cases and 911 DP cases were incorporated into the present meta-analysis. Pooled analyses demonstrated that relative to DP, DP-CAR was related to a longer operative duration [mean difference (MD) -73.69, 95% confidence interval (CI): -112.99 to -34.38, P=0.0002] and higher blood transfusion rates [odds ratio (OR) 0.29, 95% CI: 0.10 to 0.87; P=0.03]. DP-CAR was also linked to increased rates of PV resection (OR 0.17, 95% CI: 0.07 to 0.39; P<0.001) and delayed gastric emptying (DGE) (OR 0.37, 95% CI: 0.15 to 0.93, P=0.03). In contrast, R0 resection rates were higher in the DP group (OR 2.79, 95% CI: 1.90 to 4.09, P<0.001), and these patients also had a significantly improved prognosis (median survival time, 27.0 vs. 17.7 months; P<0.01) relative to the DP-CAR group. Conclusions: This analysis indicates that DP-CAR is not an effective means of improving R0 rates. However, available studies suggest that it is nonetheless a potentially valuable treatment option for pancreatic cancer patients with celiac axis involvement, and it is associated with a reasonable median survival duration of 17.7 months.