Distal and Total Pancreatectomy With En Bloc Celiac Axis Resection for Pancreatic Cancer at a High-Volume Center

This study evaluated outcomes after distal and total pancreatectomy with en bloc celiac axis resection (DP-CAR/TP-CAR), and preoperative hepatic artery embolization intended to mitigate postoperative organ ischemia.

DP-CAR and TP-CAR are surgical interventions for advanced pancreatic cancer, associated with substantial complication and recurrence rates. Despite advancements in oncologic therapy, the risks and benefits of these extensive procedures remain poorly defined.

Prospectively collected data from patients operated on between January 1, 2014, and June 30, 2025, were analyzed. The primary endpoints included overall survival and recurrence-free survival. Secondary endpoints comprised radicality of resection and incidence of postoperative complications.

Of 58 consecutively operated patients, 52 underwent neoadjuvant oncologic treatment. Surgical procedures consisted of DP-CAR (n = 38), TP-CAR (n=11), and exploratory laparotomy (n=9). Uncomplicated preoperative hepatic artery embolization was achieved in 54 patients (93.1%). Pancreatic leaks occurred in 22.2% of cases, whereas organ ischemia was observed in 16.3%. R0 and R1 resection rates were 26.5% and 73.5%, respectively. Median overall survival for patients receiving neoadjuvant oncologic treatment followed by surgery, upfront surgery, and exploratory surgery was 28.0, 23.3, and 20.1 months, respectively. The median recurrence-free survival was 6.0 months (range: 1-43), whereas the median interval from surgery to detection of distant metastases or local recurrence was 5 (range: 1-43) and 13 months (range: 3-32), respectively (P < 0.005).

DP-CAR and TP-CAR may be performed with complication rates comparable to standard distal and total pancreatectomies. Nonetheless, the elevated rate of cancer recurrence underscores the necessity of meticulous preoperative patient selection.