R0 resection of locally advanced pancreatic cancer (LAPC) involving major visceral arteries (T4 lesions) using arterial resections and reconstructions: short- and long-term outcomes

Abstract

Introduction: Surgical management of LAPC invading visceral arteries remain controversial. The objective of this study was to analyze the outcomes of resection of LAPC encasing visceral arteries using arterial resection and reconstruction. Method: The data were collected prospectively in surgical patients with LAPC involving the celiac axis (CA) or superior mesenteric artery (SMA). The post-operative (PO-OS) and post-diagnosis (PD-OS) medium overall survival, and disease-free survival (DFS) were calculated utilizing Kaplan-Meier survival probability estimates. Results: From 12/2002 to 12/2017, 26 patients with LAPC (16 males and 10 females, median age 61.5 yrs (range: 49–87 yrs)) underwent pancreatic resection with concomitant resection and reconstruction of major visceral arteries in our institution. The arterial involvement included CA (n = 13), SMA (n = 11) and both CA and SMA (n = 2). Resections included Whipple resection) (n = 16), distal pancreatectomy (n = 5), and total pancreatectomy (n = 5). Management of the arterial involvement included: resection without reconstruction (n = 4), reconstruction of one (n = 13), two (n = 7), three (n = 1), and four (n = 1) visceral arteries. All arterial reconstructions were performed using autologous veins. R0 resection was accomplished in 22, R1 in 2, and R2 in 2 patient. Median hospital stay was 13 days. Thirty-day peri-operative mortality was 4%. Six patient did not receive chemotherapy. Twenty patients received neoadjuvant and/or adjuvant chemo- or chemo-radiation therapy outside protocols. For those patients, PD-OS was 21 months, PO-OS - 19 months and DFS - 15 months (Fig.1). Conclusions: R0 resection combined with arterial resection and reconstruction can be accomplished with improved survival of patients with LAPC.