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. 2022 Apr 1;275(4):759-768.
doi: 10.1097/SLA.0000000000004054.

Arterial Resection in Pancreatic Cancer Surgery: Effective After a Learning Curve

Martin Loos  1 , Tobias Kester  1 , Ulla Klaiber  1 , André L Mihaljevic  1 , Arianeb Mehrabi  1 , Beat M Müller-Stich  1 , Markus K Diener  1 , Martin A Schneider  1 , Christoph Berchtold  1 , Ulf Hinz  1 , Manuel Feisst  2 , Oliver Strobel  1 , Thilo Hackert  1 , Markus W Büchler  1
Affiliations

Arterial Resection in Pancreatic Cancer Surgery: Effective After a Learning Curve

Martin Loos et al. Ann Surg. .

Abstract

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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Conflict of interest statement

The authors report no conflicts of interest.

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