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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| Hauptverfasser: | , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
2022
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| In: |
Annals of surgery
Year: 2022, Jahrgang: 275, Heft: 4, Pages: 759-768 |
| ISSN: | 1528-1140 |
| DOI: | 10.1097/SLA.0000000000004054 |
| Online-Zugang: | 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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| Verfasserangaben: | 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 |
MARC
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| 245 | 1 | 0 | |a Arterial resection in pancreatic cancer surgery |b effective after a learning curve |c 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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| 520 | |a 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. | ||
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