Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC

Abstract

Background and aims: It has become clear that vein resection and reconstruction for pancreatic ductal adenocarcinoma (PDAC) is the standard of care as supported by multiple guidelines. However, resection of large peri-pancreatic arteries remains debatable.

Materials and methods: This review examines the current state of vascular resection with curative intent for PDAC in the last 5 years. Herein, we consider venous (superior mesenteric vein, portal vein), as well as arterial (superior mesenteric artery, celiac trunk, hepatic artery) resection or both with or without reconstruction.

Results: Improvement of multidrug chemotherapy has revolutionized care for PDAC that should shift traditional surgical thinking from an anatomical classification of resectability to a prognostic and biological classification.

Conclusion: The present review gives an overview on the results of pancreatectomy associated with vascular resection, with consideration of new perspectives offered by the availability of better systemic therapies.

Keywords: FOLFIRINOX; Pancreatic ductal adenocarcinoma; borderline resectable; gemcitabine; locally advanced; nab-paclitaxel; neoadjuvant chemoradiotherapy; neoadjuvant chemotherapy; neoadjuvant therapy; pancreatectomy.