Original Communication| Volume 155, ISSUE 5, P919-926, May 2014

Arterial resection at the time of pancreatectomy for cancer

Published:January 24, 2014DOI:


      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.


      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.


      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.


      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.
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        • Fortner J.G.
        Regional resection of cancer of the pancreas: a new surgical approach.
        Surgery. 1973; 73: 307-320
        • Tseng J.F.
        • Raut C.P.
        • Lee J.E.
        • et al.
        Pancreaticoduodenectomy with vascular resection: margin status and survival duration.
        J Gastrointest Surg. 2004; 8: 935-949
        • Katz M.H.
        • Wang H.
        • Fleming J.B.
        • et al.
        Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma.
        Ann Surg Oncol. 2009; 16: 836-847
        • Evans D.B.
        • Farnell M.B.
        • Lillemoe K.D.
        • Vollmer Jr., C.
        • Strasberg S.M.
        • Schulick R.D.
        Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement.
        Ann Surg Oncol. 2009; 16: 1736-1744
        • Christians K.K.
        • Riggle K.
        • Keim R.
        • et al.
        Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer: Initial experience from the Medical College of Wisconsin.
        Surgery. 2013; 154: 123-131
        • Yamamoto Y.
        • Sakamoto Y.
        • Ban D.
        • et al.
        Is celiac axis resection justified for T4 pancreatic body cancer?.
        Surgery. 2012; 151: 61-69
        • Mollberg N.
        • Rahbari N.N.
        • Koch M.
        • et al.
        Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis.
        Ann Surg. 2011; 254: 882-893
        • Christians K.K.
        • Tsai S.
        • Tolat P.P.
        • Evans D.B.
        Critical steps for pancreaticoduodenectomy in the setting of pancreatic adenocarcinoma.
        J Surg Oncol. 2013; 107: 33-38
        • Edge S.
        • Byrd D.R.
        • Compton C.C.
        • et al.
        AJCC cancer staging manual.
        7th ed. Springer, Chicago2010: 243
        • Evans D.B.
        • Christians K.K.
        • Foley W.D.
        Pancreaticoduodenectomy (Whipple operation) and total pancreatectomy for cancer.
        in: Fischer J.L. Mastery of surgery. 6th ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia2012: 1445-1466
        • Appel B.L.
        • Tolat P.
        • Evans D.B.
        • Tsai S.
        Current staging systems for pancreatic cancer.
        Cancer J. 2012; 18: 539-549
        • Evans D.B.
        • Erickson B.A.
        • Ritch P.
        Borderline resectable pancreatic cancer: definitions and the importance of multimodality therapy.
        Ann Surg Oncol. 2010; 17: 2803-2805
        • Katz M.H.
        • Pisters P.W.
        • Evans D.B.
        • et al.
        Borderline resectable pancreatic cancer: the importance of this emerging stage of disease.
        J Am Coll Surg. 2008; 206: 833-846
        • Abrams R.A.
        • Lowy A.M.
        • O'Reilly E.M.
        • Wolff R.A.
        • Picozzi V.J.
        • Pisters P.W.
        Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement.
        Ann Surg Oncol. 2009; 16: 1751-1756
      1. NCCN Guidelines(R) Updates.
        J Natl Compr Canc Netw. May 1 2013; 11: xxxiv-xxxvi
        • Evans D.B.
        • Crane C.H.
        • Charnsangavej C.
        • Wolff R.A.
        The added value of multidisciplinary care for patients with pancreatic cancer.
        Ann Surg Oncol. 2008; 15: 2078-2080
        • Kang C.M.
        • Chung Y.E.
        • Park J.Y.
        • et al.
        Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer.
        J Gastrointest Surg. 2012; 16: 509-517
      2. Christians KK, Tsai S, Mahmoud A, et al. Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer - a new treatment paradigm. Oncologist. In press.