Optimal strategies for surgical resection of pancreatic body cancer: A multi-institutional cohort study.

Abstract

Pancreatic body cancer is usually considered alongside tail cancer, with distal pancreatectomy being the standard surgical approach. Nonetheless, the oncological effectiveness of distal pancreatectomy for pancreatic body cancer is uncertain, prompting consideration of pancreaticoduodenectomy as an alternative treatment. This study aimed to compare the outcomes of pancreaticoduodenectomy and distal pancreatectomy for pancreatic body cancer. Clinicopathologic parameters, surgical outcomes, and survival of patients who underwent pancreaticoduodenectomy or distal pancreatectomy for pancreatic body cancer between 2013 and 2022 from 16 institutions were retrospectively compared. Propensity score-matched analysis adjusting patients' background characteristics was also performed. Risk factors for survival were identified by Cox proportional hazards model analysis. A total of 311 patients were enrolled; 71 (23%) underwent pancreaticoduodenectomy, and 240 (77%) underwent distal pancreatectomy. In the total cohort, the rates of postoperative pancreatic fistula (13% vs 25%, P = .024) and postoperative complications above Clavien-Dindo grade III (13% vs 28%, P = .005) were higher after distal pancreatectomy. The same tendency was observed in the propensity score-matched population. Notably, the R₁ resection rate was significantly higher in distal pancreatectomy, in both total and propensity score-matched populations (1% vs 13%, P = .001 and 2% vs 17%, P = .001). Recurrence-free and overall survivals after pancreaticoduodenectomy and distal pancreatectomy were not significantly different. However, survival in distal pancreatectomy with R₁ status was worse than in pancreaticoduodenectomy or distal pancreatectomy with R₀ status. Pancreaticoduodenectomy for pancreatic body cancer can offer an equivalent outcome to distal pancreatectomy. Frequent complications and a higher risk of R₁ resection should be noted when performing distal pancreatectomy.