Pancreaticoduodenectomy and vein resection without reconstruction for locally advanced pancreatic cancer: a case series

Abstract

Background: Locally advanced pancreatic cancer (LAPC) patients who have unreconstructible SMV involvement are traditionally considered unresectable. Here we report 5 LAPC patients with unreconstructible SMV occlusion and collateralization who underwent pancreaticoduodenectomy (PD) and vein resection without reconstruction. Methods: LAPC patients from a multidisciplinary clinic were identified after retrospective review of medical records from 2013 to 2017. Clinicopathologic and operative details, post-operative complications, and oncologic outcomes were assessed. Results: Median age was 57 (range 52–64). Median time from diagnosis to resection was 8 months (range 6 – 23). All patients received preoperative radiation and chemotherapy (3 FOLFIRINOX, 2 Gem-Abraxane), for at least 4 cycles. All patients had SMA abutment and venous encasement, and 4 had complete SMV occlusion. All patients had left-sided collateralization. Median operative time was 429 minutes (range 255–600) and median EBL was 650 ml (range 250–4500). One patient experienced pancreatic fistula and GI bleeding. Median length of stay was 7 days (range 7–13). One patient had a pathologic complete response (no viable tumor), and one a marked response (scattered foci of tumor). Four patients had no lymph node metastasis, and one patient had a positive margin (uncinate). Three patients received adjuvant chemotherapy. Two patients have no evidence of disease 6 and 7 months following resection. One is alive with local recurrence 6 months following R1 resection. Two patients died with disease: one at 23 months (local recurrence at 11), and another at 20 months (distant recurrence at 14). Conclusion: PD and vein resection without reconstruction is safe and feasible in appropriately selected LAPC patients with SMV occlusion and left-sided collateralization.