Perioperative and long-term outcome of en-bloc arterial resection in pancreatic surgery. Issue 7 (July 2022)

• Record Type: Journal Article
• Authors: Wiltberger, Georg; den Dulk, Marcel; Bednarsch, Jan; Czigany, Zoltan; Lang, Sven A.; Andert, Anne; Lamberzt, Andreas; Heij, Lara R.; de Vos-Geelen, Judith; Stommel, Martijn W.J.; van Dam, Ronald M.; Dejong, Cornelis; Ulmer, Florian; Neumann, Ulf P.
• Is Part Of: HPB. Volume 24:Issue 7(2022)
• Page Start: 1119
• Page End: 1128
• Publication Date: 2022-07
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2021.12.003
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: 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. Methods: 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) 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%). Major complications after surgery were observed in 15% of cases. 90-day mortality was 5%. 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 with acceptable mortality and morbidity rates and beneficial oncological outcome.