Distal vs. total pancreatectomy with celiac axis resection in patients with locally advanced/borderline resectable pancreatic carcinoma - a retrospective cohort study.

BACKGROUND: Distal pancreatectomy with celiac axis resection (DP-CAR) is an established procedure for the resection of celiac-trunk-infiltrating carcinomas of the pancreatic corpus or cauda. In contrast, total pancreatectomy with celiac axis resection (TP-CAR) remains a controversial procedure, which is sporadically mentioned in the literature. This study aimed to compare perioperative and survival outcomes following TP-CAR with those of the established DP-CAR operation. METHODS: Between January 2010 and December 2023, 17 patients underwent DP-CAR and 8 patients TP-CAR in our institution. Pre-, intra-, postoperative, histopathological and survival data were compared between the two groups. RESULTS: The TP-CAR cohort was associated with higher rates of major complications (DP-CAR: 2[12%] vs. TP-CAR: 4[50%], p = 0.037) and stomach ischemia (DP-CAR: 1[5.9%] vs. TP-CAR: 3[37.5%], p = 0.044). Length of stay in the intensive care unit was longer for the TP-CAR group (DP-CAR:1[1-1] vs. TP-CAR:18[8-27] days, p < 0.001). One patient in our study died postoperatively, belonging to the DP-CAR group. Median overall survival (DP-CAR:21[95% CI:16-26] vs. TP-CAR 14[95% CI:11.4-16.6] months, p = 0.355) and disease-free survival (DP-CAR: 12[95% CI:9.2-14.8] vs. TP-CAR: 10.5[5.4-15.6] months, p = 0.659) were higher in the DP-CAR group, without statistically significant difference in the log-rank test. CONCLUSIONS: Compared to DP-CAR, TP-CAR was associated with higher morbidity and longer stay in the intensive care unit, while mortality remained low in this cohort. Given the limited sample size and the absence of significant survival differences, TP-CAR may be considered in highly selected patients with good performance status and adequate tumour regression after neoadjuvant chemotherapy.