Arterial Resection in Pancreatic Cancer Surgery: Effective After a Learning Curve.

Abstract

OBJECTIVE:

To investigate the perioperative and oncologic long-term outcomes of patients with LAPC after surgical resection at a high-volume center for pancreatic surgery.

BACKGROUND:

The role of surgery in LAPC with arterial involvement is controversial.

METHODS:

We analyzed 385 consecutive patients undergoing PAR (n = 195) or PAD (n = 190) of the encased artery for LAPC between January 1, 2003 and April 30, 2019.

RESULTS:

There were 183 total pancreatectomies, 113 partial pancreatoduodenectomies, 79 distal pancreatectomies, and 10 resections for tumor recurrences, including 121 multivisceral resections and 171 venous resections. Forty-three patients (11.4%) had resectable oligometastatic disease. All of the 190 patients undergoing PAD (100%) and 95 of the 195 patients undergoing PAR (48.7%) received neoadjuvant chemotherapy. The R0 (circumferential resection margin negative) resection rate was 28%. The median hospital stay was 15 days (range: 3-236). The median survival after surgery for LAPC was 20.1 months and the overall 5-year survival rate 12.5%. In-hospital mortality was 8.8% for the entire patient cohort (n = 385). With increasing case load and growing expertise, there was a significant reduction of in-hospital mortality to 4.8% (n = 186) after 2013 (P = 0.005). The learning curve of experienced pancreatic surgeons for PAR was 15 such procedures.

CONCLUSION:

Our data demonstrate that an arterial surgical approach is effective in LAPC with promising long-term survival. PAD after neoadjuvant treatment is safe. PAR is a technically demanding procedure and requires a high level of expertise.

• Authors: Martin Loos, Tobias Kester, Ulla Klaiber, André L Mihaljevic, Arianeb Mehrabi, Beat M Müller-Stich, Markus K Diener, Martin A Schneider, Christoph Berchtold, Ulf Hinz, Manuel Feisst, Oliver Strobel, Thilo Hackert, Markus W Büchler
• Journal: Annals of surgery (Ann Surg) Vol. 275 Issue 4 Pg. 759-768 (04 01 2022) ISSN: 1528-1140 [Electronic] United States
• PMID: 33055587 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Arteries (surgery)
• Humans
• Learning Curve
• Neoadjuvant Therapy (methods)
• Pancreatectomy (methods)
• Pancreatic Neoplasms (pathology)
• Pancreatic Neoplasms