Vascular Resection for Pancreas Cancer

OBJECTIVE BACKGROUND: Combined pancreatic and vascular resections are increasingly performed for pancreatic ductal adenocarcinoma (PDAC). We evaluated the outcomes after pancreatectomy with nonvascular resection (NVR), venous resection (VR), and arterial resection (AR). METHODS: Retrospective review (2011-2023) of 715 patients with PDAC treated with curative-intent surgery. Associations among clinicopathological data, perioperative therapy, time to recurrence (TTR), and overall survival (OS) were evaluated. RESULTS: Initial staging revealed 533 resectable, 98 borderline, and 84 locally advanced PDAC cases. Pancreaticoduodenectomy was the most common procedure (n = 467). NVR was performed in 351 (58.2%) patients, VR in 181 (30.0%), and AR in 70 (11.8%). The median TTR and OS did not significantly differ according to the initial staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 months) compared with NVR (18.6 and 30.5 months, P < 0.001) and AR (20.6 and 30.9 months, P = 0.004 and P = 0.017). Chemotherapy or chemoradiation significantly prolonged TTR (20.1 vs 10.2 months, P < 0.001 and 25.3 vs 16.4 months, P < 0.001) and OS (31.5 vs 17.2 months, P < 0.001 and 35.5 vs 27.5 months, P = 0.030). AR was associated with higher 90-day mortality rates. In the multivariable analysis, vascular resection was not associated with OS. Perioperative therapy, pathologic N0 status, and absence of perineural invasion were the key predictors of longer TTR and OS. CONCLUSIONS: Pancreatectomy with AR was not associated with worse oncological outcomes when controlling for perioperative therapy. However, AR was associated with higher 90-day mortality rates. Patient selection is crucial when performing AR in patients with PDAC.