Abstract
ObjectiveAdvances in multimodality treatment paralleled increasing numbers of complex pancreatic procedures with major vascular resections. The aim of this meta-analysis was to evaluate the current outcomes of arterial resection (AR) in pancreatic surgery.MethodsA systematic literature search was carried out from January 2011 until January 2020. MOOSE guidelines were followed. Predefined outcomes were morbidity, pancreatic fistula, postoperative bleeding and delayed gastric emptying, reoperation rate, mortality, hospital stay, R0 resection rate, and lymph node positivity. Duration of surgery, blood loss, and survival were also analyzed.ResultsEight hundred and forty-one AR patients were identified in a cohort of 7111 patients. Morbidity and mortality rates in these patients were 66.8% and 5.3%, respectively. Seven studies (579 AR patients) were included in the meta-analysis. Overall morbidity (48% vs 39%, p = 0.1) and mortality (3.2% vs 1.5%, p = 0.27) were not significantly different in the groups with or without AR. R0 was less frequent in the AR group, both in patients without (69% vs 89%, p < 0.001) and with neoadjuvant treatment (50% vs 86%, p < 0.001). Weighted median survival was shorter in the AR group (18.6 vs 32 months, range 14.8–43.1 months, p = 0.037).ConclusionsArterial resections increase the complexity of pancreatic surgery, as demonstrated by relevant morbidity and mortality rates. Careful patient selection and multidisciplinary planning remain important.
Highlights
Surgery for pancreatic cancer has become increasingly safe in the last decades
The inclusion periods of patients ranged from 1970 to 2018. Within these 30 studies, a total of 841 patients underwent pancreatic surgery with arterial resection or reconstruction and 6270 patients underwent a procedure without arterial resection
Neoadjuvant chemotherapy was not associated with prolonged long-term survival, our analysis suggests that it is crucial for achieving negative resection margins in this setting [12, 14, 59]
Summary
Surgery for pancreatic cancer has become increasingly safe in the last decades. Complex venous resections are no longer a criterion of unresectability [1, 2], but are a standard addition to the surgical armamentarium in most centers. With the advent of effective chemotherapy regimens (namely FOLFIRINOX and nab-paclitaxel/gemcitabine) in the last decade, an increasing number of patients with locally advanced disease at diagnosis present with a response to Langenbecks Arch Surg (2020) 405:903–919 neoadjuvant treatment [4, 5]. These patients—most of them considered inoperable 10 years ago— frequently proceed to resection, and porto-mesenteric venous resections have become routine procedures in high-volume centers in this setting [6, 7]. Arterial resections—albeit to a smaller extent—are performed in selected patients as well
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