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Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis

(2019) ANNALS OF SURGICAL ONCOLOGY. 26(3). p.772-781
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Abstract
Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P=0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P=0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19months (95 CI, 15-25months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.
Keywords
VOLUME, MODEL, ADENOCARCINOMA, DEFINITION, SURGERY, ARTERY

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MLA
Klompmaker, Sjors, et al. “Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) : An International Multicenter Analysis.” ANNALS OF SURGICAL ONCOLOGY, vol. 26, no. 3, 2019, pp. 772–81.
APA
Klompmaker, S., Peters, N. A., Van Hilst, J., Bassi, C., Boggi, U., Busch, O. R., … Roeyen, G. (2019). Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis. ANNALS OF SURGICAL ONCOLOGY, 26(3), 772–781.
Chicago author-date
Klompmaker, Sjors, Niek A Peters, Jony Van Hilst, Claudio Bassi, Ugo Boggi, Olivier R Busch, Willem Niesen, et al. 2019. “Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) : An International Multicenter Analysis.” ANNALS OF SURGICAL ONCOLOGY 26 (3): 772–81.
Chicago author-date (all authors)
Klompmaker, Sjors, Niek A Peters, Jony Van Hilst, Claudio Bassi, Ugo Boggi, Olivier R Busch, Willem Niesen, Thomas M Van Gulik, Ammar A Javed, Jorg Kleeff, Manabu Kawai, Mickael Lesurtel, Carlo Lombardo, A James Moser, Ken-ichi Okada, Irinel Popescu, Raj Prasad, Roberto Salvia, Alain Sauvanet, Christian Sturesson, Matthew J Weiss, Herbert J Zeh, Amer H Zureikat, Hiroki Yamaue, Christopher L Wolfgang, Melissa E Hogg, Marc G Besselink, Sarah L Gerritsen, Mustapha Adham, M Teresa Albiol, Frederik Berrevoet, Manuela Cesaretti, Raffaele Dalla Valle, Benjamin Darnis, Markus K Diener, Marco Del Chiaro, Thilo H Hackert, Robert Gruetzmann, Traian Dumitrascu, Helmut Friess, Seiko Hirono, Arpad Ivanecz, Anastasios Karayiannakis, Giuseppe K Fusai, Knut J Labori, Santiago Lopez-Ben, Jean-Yves Mabrut, Motoki Miyazawa, Fernando Pardo, Julie Perinel, and Geert Roeyen. 2019. “Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) : An International Multicenter Analysis.” ANNALS OF SURGICAL ONCOLOGY 26 (3): 772–781.
Vancouver
1.
Klompmaker S, Peters NA, Van Hilst J, Bassi C, Boggi U, Busch OR, et al. Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis. ANNALS OF SURGICAL ONCOLOGY. 2019;26(3):772–81.
IEEE
[1]
S. Klompmaker et al., “Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis,” ANNALS OF SURGICAL ONCOLOGY, vol. 26, no. 3, pp. 772–781, 2019.
@article{8650196,
  abstract     = {{Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes.
Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival.
Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P=0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P=0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19months (95 CI, 15-25months).
Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.}},
  author       = {{Klompmaker, Sjors and Peters, Niek A and Van Hilst, Jony and Bassi, Claudio and Boggi, Ugo and Busch, Olivier R and Niesen, Willem and Van Gulik, Thomas M and Javed, Ammar A and Kleeff, Jorg and Kawai, Manabu and Lesurtel, Mickael and Lombardo, Carlo and Moser, A James and Okada, Ken-ichi and Popescu, Irinel and Prasad, Raj and Salvia, Roberto and Sauvanet, Alain and Sturesson, Christian and Weiss, Matthew J and Zeh, Herbert J and Zureikat, Amer H and Yamaue, Hiroki and Wolfgang, Christopher L and Hogg, Melissa E and Besselink, Marc G and Gerritsen, Sarah L and Adham, Mustapha and Teresa Albiol, M and Berrevoet, Frederik and Cesaretti, Manuela and Dalla Valle, Raffaele and Darnis, Benjamin and Diener, Markus K and Del Chiaro, Marco and Hackert, Thilo H and Gruetzmann, Robert and Dumitrascu, Traian and Friess, Helmut and Hirono, Seiko and Ivanecz, Arpad and Karayiannakis, Anastasios and Fusai, Giuseppe K and Labori, Knut J and Lopez-Ben, Santiago and Mabrut, Jean-Yves and Miyazawa, Motoki and Pardo, Fernando and Perinel, Julie and Roeyen, Geert}},
  issn         = {{1068-9265}},
  journal      = {{ANNALS OF SURGICAL ONCOLOGY}},
  keywords     = {{VOLUME,MODEL,ADENOCARCINOMA,DEFINITION,SURGERY,ARTERY}},
  language     = {{eng}},
  location     = {{Geneva, Switzerland}},
  number       = {{3}},
  pages        = {{772--781}},
  title        = {{Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis}},
  url          = {{http://dx.doi.org/10.1245/s10434-018-07101-0}},
  volume       = {{26}},
  year         = {{2019}},
}

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