Pancreatectomy with arterial resection following neoadjuvant FOLFIRINOX: A single-institution experience

Arterial resection in pancreatic cancer remains controversial. This study evaluates outcomes of pancreatic resection with arterial involvement following neoadjuvant chemotherapy.

Retrospective analysis of 100 pancreatic adenocarcinoma patients undergoing resection after neoadjuvant FOLFIRINOX (2010-2024): 26 with arterial resection (ArP), 39 with portal-venous resection (PoP), and 35 without vascular involvement (NoP). Primary outcomes included perioperative morbidity, mortality, and survival.

ArP patients had significantly more stage III disease (73.1% vs 58.9% vs 28.6%, p < 0.001) but achieved acceptable R0 resection rates (76.9% vs 84.6% vs 91.4%, p = 0.04). ArP procedures required longer operative time (386 ± 71 minutes), greater blood loss (1,100 ± 560 mL), and more transfusions (57.7%; all p < 0.001). Major complications (Clavien-Dindo ≥ III) were higher in ArP (26.9% vs 21.6% vs 8.6%, p = 0.03), with extended ICU stays (3.5 ± 1.5 vs 2.0 ± 1.0 vs 1.0 ± 0.5 days). Ninety-day mortality was 0% (ArP), 2.5% (PoP), and 5.7% (NoP) (p = 0.78). Despite shorter disease-free survival in ArP (7.4 vs 9.7 vs 13.2 months, p = 0.01), median overall survival was comparable (ArP: 19.1, PoP: 18.3, NoP: 22.7 months; p = 0.0652).

Arterial resection following neoadjuvant therapy in selected pancreatic cancer patients demonstrates acceptable perioperative risk and achieves survival outcomes comparable to less advanced cases. This approach is justified in experienced high-volume centers for appropriately selected patients with favorable response to neoadjuvant therapy, offering potential cure in rare circumstances.