• Benjamin P T Loveday, Nathan Zilbert, Pablo E Serrano, Koji Tomiyama, Amélie Tremblay, Adrian M Fox, Maja Segedi, Martin O'Malley, Ayelet Borgida, Teresa Bianco, Sean Creighton, Anna Dodd, Adriana Fraser, Malcolm Moore, John Kim, Sean Cleary, Carol-Anne Moulton, Paul Greig, Alice C Wei, Steven Gallinger, Neesha Dhani, and Ian D McGilvray.
• Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; Department of Surgery, University of Auckland, Auckland, New Zealand.
• HPB (Oxford). 2019 Jun 1; 21 (6): 643-652.

BackgroundStage 3 pancreatic ductal adenocarcinoma (PDAC) is defined by arterial involvement. This study objective was to evaluate outcomes for patients with stage 3 PDAC with potentially reconstructable arterial involvement, considered for neoadjuvant therapy (NAT) and pancreatic resection, and to compare outcomes following arterial (AR) and non-arterial resection (NAR).MethodsThis study included patients from 2009 to 2016 with biopsy-proven stage 3 PDAC who were offered NAT before surgical exploration. AR was performed if required to achieve R0 resection. Time to event outcomes were analysed from diagnosis date.Results87/89 patients (97.8%) received NAT (chemotherapy 41.6%, chemotherapy/radiotherapy 56.2%). 46/89 (51.7%) underwent exploration; 31 underwent resection (AR n = 20, NAR n = 11). AR patients had longer operative time (681 vs. 563 min, p = 0.006) and more blood loss (1600 vs. 575 mL, p = 0.0004), with no difference for blood transfusion, pancreatic fistula, length of stay, reoperation, or mortality. R0 rate was 30/31. Post-resection 90-day mortality was 3.2%. Median overall survival was statistically comparable between the AR and NAR groups (19.7 vs. 28.4 months, p = 0.41).ConclusionsAR had comparable clinical and oncologic outcomes to NAR. Following careful selection and non-progression after NAT, major AR may cautiously be considered if required to obtain a negative resection margin.Copyright © 2018. Published by Elsevier Ltd.

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