Vascular Resection for Pancreas Cancer – 10-year Experience from a Single High Volume-center

医学 胰十二指肠切除术 围手术期 胰腺切除术 腺癌 单中心 旁侵犯 胰腺 病态的 内科学 胰腺导管腺癌 回顾性队列研究 胃肠病学 胰腺癌 外科 癌症
作者
David Henault,Holden Kunde,Cody Zatzman,Daniela Bevacqua,Danielle Arshinoff,Sean P. Cleary,Laura A. Dawson,Elena Elimova,Robert C. Grant,Ali Hosni,Raymond Jang,Jennifer J. Knox,Aruz Mesci,Malcolm Moore,Carol‐Anne Moulton,Trevor Reichman,Chaya Shwaartz,Erica S. Tsang,Ian D. McGilvray,Steven Gallinger
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
标识
DOI:10.1097/sla.0000000000006567
摘要

Objective & Background: Combined pancreatic and vascular resections are increasingly performed for pancreatic ductal adenocarcinoma (PDAC). We evaluated the outcomes after pancreatectomy with non-vascular resection (NVR), venous resection (VR), and arterial resection (AR). Methods: Retrospective review (2011–2023) of 715 PDAC patients treated with curative-intent surgery. Associations among clinicopathological data, perioperative therapy, time to recurrence (TTR), and overall survival (OS) were evaluated. Results: Initial staging revealed 533 resectable, 98 borderline, and 84 locally advanced PDAC cases. Pancreaticoduodenectomy was the most common procedure (n=467). NVR was performed in 351 (58.2%) patients, VR in 181 (30.0%), and AR in 70 (11.8%). The median TTR and OS did not significantly differ according to the initial staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 mo) compared to NVR (18.6 and 30.5 mo, P <0.001) and AR (20.6 and 30.9 mo, P =0.004 and P =0.017). Chemotherapy or chemoradiation significantly prolonged TTR (20.1 vs. 10.2 mo, P <0.001 and 25.3 vs. 16.4 mo, P <0.001) and OS (31.5 vs. 17.2 mo, P <0.001 and 35.5 vs. 27.5 mo, P =0.030). AR was associated with higher 90-day mortality rates. In the multivariable analysis, vascular resection was not associated with OS. Perioperative therapy, pathological N0 status, and absence of perineural invasion were the key predictors of longer TTR and OS. Conclusions: Pancreatectomy with AR was not associated with worse oncological outcomes when controlling for perioperative therapy. However, AR was associated with higher 90-day mortality rates. Patient selection is crucial when performing AR in patients with PDAC.
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