Vascular Resection for Pancreas Cancer: Ten Years Experience From a Single High-volume Center

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Research

Background:

• Pancreatic ductal adenocarcinoma (PDAC) treatment often involves combined pancreatic and vascular resections.
• Evaluating outcomes of different resection types is crucial for optimizing PDAC management.

Purpose of the Study:

• To assess the oncological and perioperative outcomes of pancreatectomy with non-vascular resection (NVR), venous resection (VR), and arterial resection (AR) in PDAC patients.
• To identify predictors of time to recurrence (TTR) and overall survival (OS) after PDAC surgery.

Main Methods:

• Retrospective review of 715 PDAC patients undergoing curative-intent surgery from 2011-2023.
• Analysis of clinicopathological data, perioperative therapy, TTR, and OS based on resection type (NVR, VR, AR).

Main Results:

• Arterial resection (AR) was performed in 11.8% of patients; venous resection (VR) in 30.0%; non-vascular resection (NVR) in 58.2%.
• VR was associated with significantly shorter TTR and OS compared to NVR and AR.
• Perioperative therapy significantly improved TTR and OS; AR had higher 90-day mortality but was not associated with worse OS in multivariable analysis.
• Pathological N0 status and absence of perineural invasion were key predictors of longer TTR and OS.

Conclusions:

• Pancreatectomy with AR is not linked to worse oncological outcomes when perioperative therapy is considered.
• AR is associated with increased 90-day mortality, highlighting the critical role of patient selection.
• Optimizing PDAC treatment requires careful consideration of resection strategy and perioperative management.