Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis

the E-AHPBA DP-CAR study group

Research output: Contribution to journalArticle

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 19 months (95 CI, 15–25 months). 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.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Pancreatectomy
Abdomen
Mortality
Confidence Intervals
Patient Selection
Area Under Curve
Survival
Neoadjuvant Therapy
Minimally Invasive Surgical Procedures
Pancreatic Neoplasms
Calibration
Multicenter Studies
Japan
Adenocarcinoma
Body Mass Index
Cohort Studies
Retrospective Studies
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) : An International Multicenter Analysis. / the E-AHPBA DP-CAR study group.

In: Annals of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

@article{b03426e24fdc4e8584c0e4eb1e5686ba,
title = "Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis",
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 19 months (95 CI, 15–25 months). 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 = "{the E-AHPBA DP-CAR study group} and Sjors Klompmaker and Peters, {Niek A.} and {van Hilst}, Jony and Claudio Bassi and Ugo Boggi and Busch, {Olivier R.} and Willem Niesen and {Van Gulik}, {Thomas M.} and Javed, {Ammar A.} and Jorg Kleeff and Manabu Kawai and Mickael Lesurtel and Carlo Lombardo and Moser, {A. James} and Okada, {Ken ichi} and Irinel Popescu and Raj Prasad and Roberto Salvia and Alain Sauvanet and Christian Sturesson and Weiss, {Matthew J} and Zeh, {Herbert J.} and Zureikat, {Amer H.} and Hiroki Yamaue and Christopher Wolfgang and Hogg, {Melissa E.} and Besselink, {Marc G.} and Gerritsen, {Sarah L.} and Mustapha Adham and {Albiol Quer}, {M. Teresa} and Frederik Berrevoet and Manuela Cesaretti and {Dalla Valle}, Raffaele and Benjamin Darnis and Diener, {Markus K.} and {Del Chiaro}, Marco and Hackert, {Thilo H.} and Robert Gr{\"u}tzmann and Traian Dumitrascu and Helmut Friess and Seiko Hirono and Arpad Ivanecz and Anastasios Karayiannakis and Fusai, {Giuseppe K.} and Labori, {Knut J.} and Santiago L{\'o}pez-Ben and Mabrut, {Jean Yves} and Motoki Miyazawa and Willem Niesen and Fernando Pardo",
year = "2019",
month = "1",
day = "1",
doi = "10.1245/s10434-018-07101-0",
language = "English (US)",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",

}

TY - JOUR

T1 - Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR)

T2 - An International Multicenter Analysis

AU - the E-AHPBA DP-CAR study group

AU - Klompmaker, Sjors

AU - Peters, Niek A.

AU - van Hilst, Jony

AU - Bassi, Claudio

AU - Boggi, Ugo

AU - Busch, Olivier R.

AU - Niesen, Willem

AU - Van Gulik, Thomas M.

AU - Javed, Ammar A.

AU - Kleeff, Jorg

AU - Kawai, Manabu

AU - Lesurtel, Mickael

AU - Lombardo, Carlo

AU - Moser, A. James

AU - Okada, Ken ichi

AU - Popescu, Irinel

AU - Prasad, Raj

AU - Salvia, Roberto

AU - Sauvanet, Alain

AU - Sturesson, Christian

AU - Weiss, Matthew J

AU - Zeh, Herbert J.

AU - Zureikat, Amer H.

AU - Yamaue, Hiroki

AU - Wolfgang, Christopher

AU - Hogg, Melissa E.

AU - Besselink, Marc G.

AU - Gerritsen, Sarah L.

AU - Adham, Mustapha

AU - Albiol Quer, M. Teresa

AU - Berrevoet, Frederik

AU - Cesaretti, Manuela

AU - Dalla Valle, Raffaele

AU - Darnis, Benjamin

AU - Diener, Markus K.

AU - Del Chiaro, Marco

AU - Hackert, Thilo H.

AU - Grützmann, Robert

AU - Dumitrascu, Traian

AU - Friess, Helmut

AU - Hirono, Seiko

AU - Ivanecz, Arpad

AU - Karayiannakis, Anastasios

AU - Fusai, Giuseppe K.

AU - Labori, Knut J.

AU - López-Ben, Santiago

AU - Mabrut, Jean Yves

AU - Miyazawa, Motoki

AU - Niesen, Willem

AU - Pardo, Fernando

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 19 months (95 CI, 15–25 months). 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.

AB - 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 19 months (95 CI, 15–25 months). 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.

UR - http://www.scopus.com/inward/record.url?scp=85058447086&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058447086&partnerID=8YFLogxK

U2 - 10.1245/s10434-018-07101-0

DO - 10.1245/s10434-018-07101-0

M3 - Article

C2 - 30610560

AN - SCOPUS:85058447086

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

ER -