Vascular resection for locally advanced pancreatic malignancies: time-trend and outcome analysis from 100 consecutive resections at a high-HPB volume center

Abstract

Introduction: Involvement of major vascular structures has been considered a limiting factor for resectable advanced tumors. The aim of this study is to investigate the clinical outcomes of patients with advanced APA with vascular resection and to identify significant survival predicting variables. Material and methods: We retrospectively reviewed our experience of consecutive pancreatic surgeries with VR, achieved at Sanchinarro University Hospital (Madrid, Spain) from 2007 to December 2017. Results: A total of 100 patients underwent VR for locally advanced pancreatic cancer. The average age of all patients was 60 years and the mean operating time (560 min, range 400–900). We performed 38 pancreaticoduodenectomies (PD), 20 distal-pancreatectomies (DP), 42 total pancreatectomy (TP). Furthermore, the patients were classified according to the type of VR: venous vascular resection (72 patients); arterial vascular resection (16 patients); arterial and venous vascular resection (12 patients)). The mean hospital stay was 16 days in PD group, 12 days in DP group and 15 days in TP group. Major vascular reconstruction was accomplished through Goretex® patch (n = 17), primary end-to-end anastomosis (n = 61), tangential resection (n = 22). In 30 % histopathologic examination revealed cancer invasion of the vessel, whereas the remainder had peritumoral inflammation extending to the vessel wall. Two-year survival rate were 22%. Conclusion: Major arterial vascular resection to achieve macroscopic tumor clearance can be performed safely with acceptable operative morbidity and mortality. Nevertheless it is justified only in carefully selected cases.