Distal Pancreatectomy with Celiac Artery Resection (DP-CAR)

The distal pancreatectomy with celiac axis resection (DP-CAR) expands surgical eligibility for a subgroup of patients with pancreatic cancer. Patients are eligible in case of a tumor in the pancreatic tail or tail that involves the celiac axis. The aorta, gastroduodenal and superior mesenteric arteries should not be involved, as the operation depends on collateral liver and stomach perfusion after resection of the celiac axis. This chapter describes a standardized approach to DP-CAR based on expert consensus and international evidence. The operation is safe and effective when performed at specialized high-volume centers on carefully selected patients who received neoadjuvant chemotherapy. In those cases, mortality rates are acceptable and median overall survival times can exceed 30 months. However, the aggregated median overall survival time based on 22 published reports (N = 524) is 21 months. Performing DP-CAR in older patients with serious co-morbidities, lack of neoadjuvant chemotherapy, extensive vascular resections, and/or lack of procedure-specific surgical experience may lead to detrimental outcomes including a higher risk of 90-day mortality.