Analysis of Short-Term Outcomes in Pancreatic Surgery with Vascular Resection from a Prospective Multicenter Global Study

Abstract

Background: Pancreatic resection with concomitant vascular resection is increasingly practiced with outcomes mainly reported from specialist centers but lacking results from prospective global data. This study aimed to investigate factors associated with short-term outcomes after vascular resections in pancreatic surgery worldwide.

Patients and methods: Data were extracted from a prospective, multicenter, international cross-sectional snapshot study in 2021 (pancreasgroup.org) assessing short-term outcomes after pancreatic surgery worldwide (NCT04652271). In the patient cohort of pancreatic surgery with simultaneous vascular resection for various diseases, short-term outcomes were reported and compared with established benchmark values. Factors affecting major complications, mortality, and histopathological resection status were assessed in multivariable logistic regression analyses with interaction testing.

Results: From a total of 3926 patients undergoing pancreatic surgery, 565 had associated vascular resections, of which 444 had venous resections alone and 121 had arterial resections alone or with concomitant venous resection. Of the 153 (47%) benchmark cases with pancreatoduodenectomy and venous resection, median postoperative morbidity fell within established benchmark criteria. Median 90-day major complication and mortality rates were similar in pancreatic resection with venous, arterial or no vascular resections (45 and 10%, 47 and 6.6%, 42 and 9.6% respectively). Patients undergoing arterial resections that developed a clinically relevant pancreatic fistula faced substantially elevated odds of 90-day mortality (OR 8.8 CI 1.6-48). In pancreatic ductal adenocarcinoma, the R1 rate was 26%, neoadjuvant chemotherapy being protective for both overall and venous-specific margins.

Conclusions: Vascular pancreatic surgery is performed across diverse healthcare settings worldwide. While perioperative complications were comparable to nonvascular pancreatic resections, the observed 90-day mortality was considerable overall. International collaborative efforts should focus on understanding practice variations and improve accessibility of optimal perioperative care to promote rescue capabilities.

Keywords: Morbidity; Mortality; Pancreas surgery; Pancreatic neoplasms; Pancreatoduodenectomy; Vascular resection.