Arterial Embolization Does Not Decrease Morbidity after Distal Pancreatectomy Plus Celiac Trunk Resection: A Spanish Muticentre Study

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a surgical procedure with high morbidity and mortality performed in patients with locally advanced pancreatic cancer. Preoperative embolization of hepatic artery (PHAE) has been postulated as a technical option to decrease morbidity and mortality. Objective: comparison of morbidity and mortality at 90 days, operative time, hospital stay and survival between patients that performed DP-CAR with and without PHAE Methods: Observational retrospective multicentre study. Inclusion criteria: patient operated in Spanish Centres from a pancreatic cancer performing DP-CAR until 31 March 2018. Several preoperative, intraoperative and postoperative data were studied (Table 1). Complications were measured with Clavien classification at 90 days. Specific pancreatic complications were measured using ISGPS classifications. Resection margins were classified using Royal College of Pathologists. Chi-square or Student's t tests were used to compare categorical or continuous variables, respectively. Kaplan–Meier estimator was used to calculate overall survival and survival differences were compared with the log-rank test. Data were analyzed using R version 3.1.3 (http://www.r-project.org) and the appropiate packages. Level of significance was set at 0.05. Results: 41 patients were studied. 26 patients were not embolized (NO-PHAE group) and 15 patients received PHAE (36.5%). Only preoperative BMI and percentage of neoadjuvant chemotherapy were the only preoperative variables different between both groups. Operative time was shorter in PHAE group. Morbidity and mortality at 90 days and hospital stay were higher in the PHAE group. No statistical difference in overall survival was observed between both groups (p=0.14). Conclusion: Our study showed that PHAE is not related with less postoperative morbidity or better survival. Even more major morbidity (Clavien III-IV) and mortality was higher in PHAE group. The only benefit of PHAE was shorter operative time. A randomized clinical trial is needed to confirm real benefit of PHAE in DP-CARTabled 1Table 1.