Perioperative Outcome of en-bloc arterial resection in pancreatic surgery

Introduction Pancreatic tumors are frequently diagnosed in a locally advanced stage with poor prognosis if untreated. This study assesses the safety and oncological outcomes of pancreatic surgery with arterial en-bloc resection.

Method We retrospectively reviewed a prospectively maintained database of patients who underwent a pancreatic resection with arterial resection between 2011 and 2020. Univariable analyses were used to assess prognostic factors for survival.

Results Forty consecutive patients (22 female; 18 male) with a median age of 63 years undergoing arterial resections were included. Surgical procedures consisted of 19 pancreatoduodenectomies (PD, 48%), 16 distal splenopancreatectomy (DSP, 40%), and 5 total pancreatectomies (TP, 12%). Arterial resection included hepatic arteries (HA, N=23), coeliac trunk (TC, N=15) and superior mesenteric artery (SMA, N=2). Neoadjuvant therapy was applied in 22 patients (58%), with FOLFIRINOX as most applied regime (64%; 14/22), followed by Gemcitabine + nab-Paclitaxel (27%; 6/22), and others (9%; 2/22). Overall postoperative morbidity rate was 60 % and major complications (Clavien Dindo grade ≥IIIb) after surgery were observed in 15 % of cases. 90-day mortality was 5 %. After a median follow-up of 56 months (2 - 125 months), 13 patients (34.2 %) were still alive. Median disease-free survival and median overall survival were for the R0/CRM- group 22.8 months and 27.9 months, 9.5 and 19.8 months for the R0/CRM+ group, and 10.1 and 13.1 months for the R1 group, respectively.

Conclusion In highly selected patients, arterial en bloc resection can be performed safely with comparable mortality and morbidity rates compared with pancreatic resections without arterial resections.

Publication History

Article published online:
07 September 2021