• Annals of surgery · Apr 2022

    Arterial Resection in Pancreatic Cancer Surgery: Effective After a Learning Curve.

    • Martin Loos, Tobias Kester, Ulla Klaiber, André L Mihaljevic, Arianeb Mehrabi, Beat M Müller-Stich, Markus K Diener, Martin A Schneider, Christoph Berchtold, Ulf Hinz, Manuel Feisst, Oliver Strobel, Thilo Hackert, and Markus W Büchler.
    • Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
    • Ann. Surg. 2022 Apr 1; 275 (4): 759-768.

    ObjectiveTo investigate the perioperative and oncologic long-term outcomes of patients with LAPC after surgical resection at a high-volume center for pancreatic surgery.BackgroundThe role of surgery in LAPC with arterial involvement is controversial.MethodsWe analyzed 385 consecutive patients undergoing PAR (n = 195) or PAD (n = 190) of the encased artery for LAPC between January 1, 2003 and April 30, 2019.ResultsThere were 183 total pancreatectomies, 113 partial pancreatoduodenectomies, 79 distal pancreatectomies, and 10 resections for tumor recurrences, including 121 multivisceral resections and 171 venous resections. Forty-three patients (11.4%) had resectable oligometastatic disease. All of the 190 patients undergoing PAD (100%) and 95 of the 195 patients undergoing PAR (48.7%) received neoadjuvant chemotherapy. The R0 (circumferential resection margin negative) resection rate was 28%. The median hospital stay was 15 days (range: 3-236). The median survival after surgery for LAPC was 20.1 months and the overall 5-year survival rate 12.5%. In-hospital mortality was 8.8% for the entire patient cohort (n = 385). With increasing case load and growing expertise, there was a significant reduction of in-hospital mortality to 4.8% (n = 186) after 2013 (P = 0.005). The learning curve of experienced pancreatic surgeons for PAR was 15 such procedures.ConclusionOur data demonstrate that an arterial surgical approach is effective in LAPC with promising long-term survival. PAD after neoadjuvant treatment is safe. PAR is a technically demanding procedure and requires a high level of expertise.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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