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.
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Article info
Publication history
Published online: January 24, 2014
Accepted:
January 16,
2014
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
