Arterial Resections in Pancreatic Cancer-An Updated Systematic Review and Meta-Analysis

Complete oncological resection of pancreatic cancer remains the cornerstone in treatment of pancreatic cancer. Anatomical relations to major vessels continue to play an ongoing important role in the decision-making regarding treatment options in pancreatic cancer. Despite concomitant venous resections being routinely performed in major centers, arterial resections remain controversial. The aim of this study was to compare the short- and long-term outcomes of pancreatic cancer surgery with concomitant arterial resections to standard non-arterial resections from modern studies. We included studies comparing pancreatic cancer surgery with arterial resections to standard non-arterial surgery for pancreatic cancer published from 2018 to 2024. A total of seven articles involving 5465 patients met the inclusion criteria and were included for analysis. Arterial resections are associated with a greater risk of mortality compared to standard resections (Risk ratio (RR): 3.28; 95% confidence interval (CI) [0.75-14.46]; p = 0.0365). There were no significant differences in overall morbidity (RR: 1.48; 95% CI [1.16-1.89]; p = 0.2923) or serious complications (Mean Difference (MD): 2.6; 95% CI: [-21.52-16.32]; p = 0.738). Arterial resections were associated with a 3.1-fold increased chance of R0 resection (RR: 3.11; 95% CI [1.65-5.86]; p < 0.0227). Arterial resection in pancreatic cancer continues to be associated with an increased risk of mortality; however, recent studies show no significant increase in morbidity whilst significantly increasing R0 resections.