Indications and Perioperative Outcomes for Pancreatectomy with Arterial Resection.

Abstract

BACKGROUND:

Pancreatectomy with arterial resection (AR) is performed infrequently. As indications evolve, we evaluated indications, outcomes, and predictors of mortality, morbidity, and survival after AR.

STUDY DESIGN:

We performed a single-institution review of elective pancreatectomies with AR (from July1990 to July 2017). Univariate and multivariate analyses were performed for predictors of outcomes and survival.

RESULTS:

A total of 111 patients underwent pancreatectomy with AR including any hepatic (54%), any celiac (44%), any superior mesenteric (14%), or multiple ARs (14%), with revascularization in 55%. The majority of cases were planned (77%) and performed post-2010 (78%). Overall 90-day major morbidity (≥grade III) and mortality were 54% and 13%, respectively, due to post-pancreatectomy hemorrhage (PPH), postoperative pancreatic fistula (POPF), or ischemia in the majority of cases. There was a significant decrease in mortality post-2010 (9% vs 29%, p = 0.02), and this was protective on multivariate analysis (odds ratio [OR] 0.1, p = 0.004); PPH increased mortality (OR 6.1, p < 0.001). Post-pancreatectomy hemorrhage was associated with major morbidity (OR 5.1, p = 0.005), reoperation (OR = 23.0, p = 0.004), ICU (OR 5.5, p < 0.001), and readmission (OR 2.6, p = 0.004). Other morbidity predictors were AR with graft (OR 4.0, p = 0.031) and POPF (OR 3.1, p = 0.003). Median survival was 28.5 months and improved for ductal adenocarcinoma after neoadjuvant chemotherapy (p = 0.038). There were no differences in survival based on AR type.

CONCLUSIONS:

Regardless of indication or type, pancreatectomy with AR is associated with risks greater than standard resections. Mortality has decreased in the modern era; however, morbidity remains high from hemorrhagic, fistula, or ischemia-related complications. Mitigation measures are needed if advanced resections are considered with increasing frequency given the potential oncologic benefit of AR in selected cases after modern chemotherapy.

• Authors: May C Tee, Adam C Krajewski, Ryan T Groeschl, Michael B Farnell, David M Nagorney, Michael L Kendrick, Sean P Cleary, Rory L Smoot, Kristopher P Croome, Mark J Truty
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 227 Issue 2 Pg. 255-269 (08 2018) ISSN: 1879-1190 [Electronic] United States
• PMID: 29752997 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Female
• Humans
• Male
• Middle Aged
• Pancreatectomy (methods, mortality)
• Pancreatic Neoplasms (surgery)
• Patient Selection
• Postoperative Complications (mortality)
• Retrospective Studies
• Survival Rate
• Treatment Outcome
• Vascular Surgical Procedures (methods, mortality)