Pancreaticoduodenectomy combined with vascular resection and reconstruction for patients with locally advanced pancreatic cancer: a multicenter, retrospective analysis

Abstract

Objective: The aim of this study was to present the therapeutic outcome of patients with locally advanced pancreatic cancer treated with pancreatoduodenectomy combined with vascular resection and reconstruction in addition to highlighting the mortality/morbidity and main prognostic factors associated with this treatment.

Materials and methods: We retrospectively analyzed the clinical and pathological data of a total of 566 pancreatic cancer patients who were treated with PD from five teaching hospitals during the period of December 2006-December 2011. This study included 119 (21.0%) patients treated with PD combined with vascular resection and reconstruction. We performed a detailed statistical analysis of various factors, including postoperative complications, operative mortality, survival rate, operative time, pathological type, and lymph node metastasis.

Results: The median survival time of the 119 cases that received PD combined with vascular resection was 13.3 months, and the 1-, 2-, and 3-year survival rates were 30.3%, 14.1%, and 8.1%, respectively. The postoperative complication incidence was 23.5%, and the mortality rate was 6.7%. For the combined vascular resection group, complications occurred in 28 cases (23.5%). For the group without vascular resection, complications occurred in 37 cases (8.2%). There was significant difference between the two groups (p = 0.001). The degree of tumor differentiation and the occurrence of complications after surgery were independent prognostic factors that determined the patients' long-term survival.

Conclusions: Compared with PD without vascular resection, PD combined with vascular resection and reconstruction increased the incidence of postoperative complications. However, PD combined with vascular resection and reconstruction could achieve the complete removal of tumors without significantly increasing the mortality rate, and the median survival time was higher than that of patients who underwent palliative treatment. In addition, the two independent factors affecting the postoperative survival time were the degree of tumor differentiation and the presence or absence of postoperative complications.

Figure 1. Comparison of the survival curves of the 119 cases treated with PD combined with vascular resection and reconstruction and those of the 447 cases treated with PD without vascular resection and reconstruction.

Figure 2. The relationship between the parameters of patients treated with combined vascular resection and reconstruction and the postoperative survival time.

A. The patients were divided into four groups according to age: <45 years old, 45 to 60 years old, 60 to 75 years old, and >75 years old. The comparison between the first group and the rest of the groups yielded p<0.05. B. The patients were divided into two groups according to the presence or absence of lymph node metastasis. The median survival time of these two groups was 9.2 and 14.9 months, respectively (p = 0.179). C. The patients were divided into four groups according to the operative time: less than 450 min, 450 to 550 min, 550 to 650 min, and more than 650 min. The median survival time and the 95% confidence intervals were 15.5 (8.2, 22.8), 10.3 (6.8, 13.7), 10.7 (6.0, 15.4), and 11.4 (5.5, 17.3), respectively, with p = 0.556. D. The patients were divided into four groups according to tumor diameter: less than 3 cm, 3 to 4 cm, 4 to 5 cm, and greater than 5 cm. The median survival times and 95% confidence intervals were 15.1 (8.2, 22.0), 10.3 (7.4, 13.2), 9.7 (7.0, 12.5), and 14.7 (8.3, 21.2), respectively, with p = 0.834.

Figure 3. The relationship between the parameters of patients treated with combined vascular resection and reconstruction and postoperative survival time.

A. The patients were divided into three groups based on the degree of differentiation. The median survival times and 95% confidence intervals for each group were 5.9 (4.3, 7.4), 14.9 (10.7, 19.2), and 20.6 (0, 45.1), respectively, with p = 0.002. B. The patients were divided into two groups with or without postoperative complications. The median survival times and 95% confidence intervals were 7 (4.0, 10.0) and 15.9 (11.6, 20.1), respectively, with p = 0.002. C. The patients were divided into four groups according to the different methods of vascular reconstruction. The median survival time and 95% confidence intervals for each group were 14.1 (7.1, 21.1), 13.1 (8.5, 17.8), 12.9 (8.0, 17.8), and 9.2 (4.0, 14.3), respectively, with p = 0.857. D. The patients were divided into three groups according to the volume of intraoperative blood loss: less than 800 ml, 800 to 1500 ml, and more than 1500 ml. The median survival times and 95% confidence intervals for each group were 13.2 (9.7, 16.8), 12.7 (7.1, 18.3), and 9.1 (5.4, 12.7), respectively, with p = 0.659.