Artery-First Pancreatectomy with Superior Mesenteric - Portal Vein Resection and Reconstruction: Two Large Institutions Experience from East and West

Abstract

Introduction: Potential benefits of pancreatectomies associated to vein resection (PAVR) for pancreatic cancer are still contradictory. Although some recent papers suggested artery-first approach facilitated PAVR, evidence is sparse. The aim of this study is to analyze outcomes of artery-first approach with PAVR by using two large institutions from different regions. Methods: We identified consecutive series of patients with pancreatic cancer who underwent artery-first approach with PAVR in Karolinska University Hospital (KUH) and Cancer institute hospital, Japanese foundation of cancer research (JFCR) from 2008 to 2018. We compared the short- and long-term results between two centers. Results: Among total 506 patients, 211 patients were from KUH and 295 patients were from JFCR. The higher incidence of total pancreatectomy was shown in KUH (24.6% vs 0.3%, P < 0.001). The higher incidence of primary end-to-end anastomosis was shown in JFCR (92.5% vs 62.6%, P = 0.017). There was no significant difference in intraoperative estimated blood loss (KUH: 630ml, JFCR: 600ml), severe complications rate (8.5%, 5.1%), and mortality (2.4%, 0.7%). Primary end-to-end anastomosis was mainly performed even if the length of PV/SMV resection was 5cm or more and achieved successfully without thrombus (overall cases: 98.0%, 5cm or more: 93.5%) Conclusions: We reported favorable short-term outcomes and acceptable long-term outcomes of artery-first approach with PAVR for pancreatic cancer from the two high-volume centers in the east and west. Primary end-to-end anastomosis after artery-first pancreatectomy was safe and feasible even if the length of PV/SMV resection was 5cm or more.