SS9. Vascular Reconstruction plays an Important Role in the Treatment of Pancreatic Adenocarcinoma

Abstract

Previous studies have proven the feasibility of performing a pancreaticoduodenectomy (Whipple) in patients with portal veinn/superior mesenteric vein (PV/SMV) or arterial invasion. We report our institutional experience with the use of a variety of vascular reconstructive methods during pancreatic resections for adenocarcinoma. A retrospective review was performed identifying all Whipple and total pancreatectomy patients from January 2003 through February 2013. All venous (PV/SMV) and arterial (SMA/hepatic) reconstructions were extracted and reviewed to determine survival and perioperative complications. During the 10-year study period, 270 Whipple and total pancreatectomy procedures were performed, of which 183 were for adenocarcinoma of the pancreas. A total of 60 of 183 (32.8%) vascular reconstructions were found, 49 venous and 11 arterial. Venous reconstruction included 37 (61.7%) primary repairs, 4 (6.7%) reconstructions with cryovein, 3 (5.0%) repairs with autologous vein patch, 3 (5.0%) autologous saphenous reconstructions, and 2 (3.33%) portocaval shunts. Additionally, there were 11 (18.3%) arterial reconstructions (seven hepatic artery and four superior mesenteric artery). There was one perioperative death (1.7%). One-year survival for all reconstructions was 70.3%, which is equivalent to T3 lesions that did not receive vascular reconstruction (72.6%), with a median survival time of 515 days and 12 patients still alive. Survival time was comparable with each type of venous reconstruction, averaging 528 days (11 of 49 patients still alive). Of the venous reconstructions, four of 49 (8.2%) resulted in PV thrombosis, three within the primary repair group and one delayed thrombosis within the cryovein group. There was no thrombosis in any patients after arterial reconstruction. An aggressive approach for stage II pancreatic cancers with venous or arterial invasion can be performed with comparable results when executed by an experienced institution with skilled oncologic and vascular surgeons.