Faculty Collaboration Database

Arterial resection at the time of pancreatectomy for cancer. Surgery 2014 May;155(5):919-26

Date

05/03/2014

Pubmed ID

24787115

DOI

10.1016/j.surg.2014.01.003

Scopus ID

2-s2.0-84899659181 (requires institutional sign-in at Scopus site)   82 Citations

Abstract

BACKGROUND: Tumor-induced arterial abutment/encasement has been traditionally a contraindication to surgery in patients with localized pancreatic cancer (PC). One recent meta-analysis reported greater mortality rates in this setting. We report herein a series of planned arterial resections in carefully selected patients who responded favorably to combined modality therapy for localized PC.

METHODS: We reviewed all patients with PC and arterial encasement treated between May 2011 and September 2013; all patients received an extensive course of neoadjuvant therapy before surgery.

RESULTS: Of 15 patients taken to surgery, 2 had peritoneal disease at laparoscopy, and therefore, laparotomy was not performed. Pancreatectomy (pancreaticoduodenectomy, 3; distal, 8; central pancreatectomy, 1; total, 1) was performed in the remaining 13, 10 of whom required arterial resection. The most common operation was an Appleby procedure. Of 10 patients who underwent combined pancreatectomy and arterial resection, their median age was 62 years (range, 33-75), median operative time was 7.5 hours, and median blood loss was 725 mL. Complications occurred in 3 of 15 patients with no perioperative mortality. Median duration of hospital stay was 9 days (range, 5-19). An R0 resection was achieved in 11 (85%) of 13 patients. At a median follow-up of 21 months, 8 of these 13 resected patients (62%) are alive without disease.

CONCLUSION: Planned arterial resection at the time of pancreatectomy can be performed with acceptable morbidity and mortality; patient selection and induction therapy are likely critically important variables that seem to impact patient outcome. Those patients with stable or responding disease after induction therapy represent the subset of patients with potentially favorable tumor biology in whom extended resections may enhance survival duration.

Author List

Christians KK, Pilgrim CH, Tsai S, Ritch P, George B, Erickson B, Tolat P, Evans DB

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Professor in the Medicine department at Medical College of Wisconsin
Parag P. Tolat MD Chief, Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Blood Loss, Surgical
Celiac Artery
Female
Follow-Up Studies
Hepatic Artery
Humans
Length of Stay
Male
Mesenteric Arteries
Middle Aged
Operative Time
Pancreas
Pancreatectomy
Pancreatic Neoplasms
Patient Selection
Retrospective Studies
Treatment Outcome
Vascular Surgical Procedures