[Comparison of distal pancreatectomy with celiac axis resection and sub-adventitial divestment technique for locally advanced or borderline resectable pancreatic body cancer].

To compare the outcomes of modified Appleby procedure and sub-adventitial divestment technique for locally advanced or borderline resectable pancreatic body cancer. A total of consecutive 58 patients(33 males and 25 females) who were diagnosed as locally advanced or borderline resectable pancreatic body cancer and underwent distal pancreatectomy at Pancreas Center, First Affiliated Hospital of Nanjing Medical University between September 2013 and May 2019 were retrospectively reviewed. The age((IQR)) was 62(9)years(range: 43 to 79 years). Thirty-one patients underwent distal pancreatectomy with celiac axis resection (DP-CAR) and 27 patients underwent distal pancreatectomy with sub-adventitial divestment technique(SDT). Perioperative parameters and follow-up data of these patients were analyzed. Quantitative data were compared with Wilcoxon test while categorical variables were compared with χ test or Fisher's exact test. Survival results were estimated by the Kaplan-Meier survival method with a Log-rank test. There were no differences in age,gender,body mass index,abdominal symptoms,comorbidity or preoperative serum CA19-9 between two groups(all >0.05). Obvious preoperative weight loss was more common in the group of SDT(48.1%(13/27) 19.4%(6/31),χ²=5.431,=0.020). Longer operative time(310(123) minutes . 254(137)minutes, =2.277,=0.023),higher rate of combined organ resection(41.9%(13/31) 14.8%(4/27),χ²=5.123,=0.041) and longer postoperative hospital stay(15(10) days 11(5)days,=2.292,=0.022) were observed in the group of DP-CAR. Moreover,rate of overall morbidities was also higher (71.0%(22/31) 29.6%(8/27),χ=9.876,=0.003),implicated by clinically relevant postoperative pancreatic fistula(61.3%(19/31) 29.6%(8/27),χ=5.814,=0.020) in the DP-CAR group. Tumor size of the DP-CAR group was bigger(4.9(1.5)cm 4.0(1.2)cm,=2.343,=0.019) but no difference was seen between the DP-CAR group and SDT group in R0+R1(<1 mm) resection rate (84.0%(21/25) 90.0%(18/20),=0.678) and LNR(12.0(23.0)% . 9.0(18.0)%,=1.238,=0.216),as well as median disease free survival(11.7 months 11.4 months,=0.019,=0.892) and median overall survival(16.3 months 13.7 months,=0.172,=0.679). Both DP-CAR and distal pancreatectomy with SDT are relatively safe and feasible for locally advanced or borderline resectable pancreatic body cancer. Compared with arterial resection,SDT may contribute to lower rates of postoperative complications and shorter duration of hospitalization,but no significant benefit is seen in long-term survival.