Is survival from resection of pancreatic adenocarcinoma with major arterial involvement any different than venous/minor arterial resection?

Abstract

310 Background: Major arterial involvement is considered a contraindication to surgical resection for pancreatic adenocarcinoma (PA). We hypothesized that survival for patients (pts) with T3 or T4 disease with major arterial involvement (SMA/Celiac Axis) undergoing pancreatic resection was worse than those undergoing venous resections. Methods: We included all pts with T3 or T4 PA in the SEER database from 2004-2007. Patients were divided into those involving the portal vein/SMV/GDA/hepatic artery and those involving the SMA and celiac axis. Non-surgical control arm (CA) included pts who were recommended surgery but did not undergo it. Multivariate survival analyses were performed using the cox-proportional hazards model. Results: We identified 571 pts, of whom 323(56%) underwent resection. Median disease specific survival of pts undergoing surgery with SMA, Celiac involvement was 12, 8 vs. 7, 6 months respectively in the CA(p=0.01). Pts undergoing venous resection had a longer survival than those undergoing arterial resection in multivariate models (18 vs. 12 months, p=0.001) Conclusions: Resection for pancreatic adenocarcinoma with major arterial involvement is associated with a poorer survival as compared to those with venous/minor arterial involvement. This study validates the current practice of considering major arterial involvement as a contraindication to resection. [Table: see text]