Surgery for Borderline Resectable and Locally Advanced Pancreatic Cancer with Arterial Encasement after Neoadjuvant Therapy

To investigate complications and survival following surgical resection for pancreatic cancer with arterial encasement. Surgery for pancreatic cancer with extensive involvement (encasement) of the major visceral arteries remains a topic of debate due to concerns regarding morbidity, mortality, and uncertain oncological benefit. Pancreatic cancer patients with arterial encasement of the superior mesenteric artery (SMA), the hepatic artery (HA), and/or the celiac artery (CA) at baseline imaging who underwent resection after neoadjuvant therapy at the University of Colorado Hospital between January 2017 and September 2023 were included. Surgical and oncological outcomes were evaluated. Of the 61 patients who underwent resection, arterial encasement was diagnosed at SMA in 20 (33%), HA in 14 (23%), CA in four (6.6%), replaced HA in one (1.6%), and two or more arteries in 22 (36%). Arterial resection was performed in 14 patients (23%) and arterial divestment was performed in 47 patients (77%). Major morbidity rate (Clavien-Dindo grade ≥3) was 21.3% and 90-day mortality rate was 4.9%. R0 resection rate was 70.5%. Median overall survival (OS) after surgery was 21.2 months with 5-year survival rate of 22.1%. Patients with pathological node-negative disease exhibited a longer median OS (29.1 vs. 16.6 mo, P=0.004), and a higher 5-year survival rate of 37.8% vs. 7.4%. Even in pancreatic cancer patients with arterial encasement, surgery following NAT can be performed safely and offer long-term survival. The development of preoperatively assessable biomarkers for chemotherapy response and regional nodal metastasis is necessary to improve patient selection.