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Arterial resection in pancreatic cancer surgery: effective after a learning curve

Objective: - To investigate the perioperative and oncologic long-term outcomes of patients with LAPC after surgical resection at a high-volume center for pancreatic surgery. - Background: - The role of surgery in LAPC with arterial involvement is controversial. - Me...

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Main Authors: Loos, Martin (Author) , Kester, Tobias (Author) , Klaiber, Ulla (Author) , Mihaljevic, André Leopold (Author) , Mehrabi, Arianeb (Author) , Müller, Beat P. (Author) , Diener, Markus K. (Author) , Schneider, Martin (Author) , Berchtold, Christoph (Author) , Hinz, Ulf (Author) , Feißt, Manuel (Author) , Strobel, Oliver (Author) , Hackert, Thilo (Author) , Büchler, Markus W. (Author)
Format: Article (Journal)
Language:English
Published: 2022
In: Annals of surgery
Year: 2022, Volume: 275, Issue: 4, Pages: 759-768
ISSN:1528-1140
DOI:10.1097/SLA.0000000000004054
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/SLA.0000000000004054
Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/annalsofsurgery/Fulltext/2022/04000/Arterial_Resection_in_Pancreatic_Cancer_Surgery_.21.aspx
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Author Notes:Martin Loos, MD, Tobias Kester, Ulla Klaiber, MD, Andre L. Mihaljevic, MD, MSc, Arianeb Mehrabi, MD, Beat M. Müller-Stich, MD, Markus K. Diener, MD, Martin A. Schneider, MD, Christoph Berchtold, MD, Ulf Hinz, MSc, Manuel Feisst, MSc, Oliver Strobel, MD, Thilo Hackert, MD, and Markus W. Büchler, MD
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Summary:Objective: - To investigate the perioperative and oncologic long-term outcomes of patients with LAPC after surgical resection at a high-volume center for pancreatic surgery. - Background: - The role of surgery in LAPC with arterial involvement is controversial. - Methods: - We 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. - Results: - There 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. - Conclusion: - Our 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.
Item Description:Date: Jun 12, 2020
Gesehen am 01.04.2022
Physical Description:Online Resource
ISSN:1528-1140
DOI:10.1097/SLA.0000000000004054

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