Prognostic Impact of type of Arterial Resection on Outcomes of Pancreatectomy with Arterial Resection for Pancreatic Adenocarcinoma

OBJECTIVE: To evaluate the prognostic implications of the type of arterial resection performed during pancreatectomy with arterial resection (PAR) for adenocarcinoma. SUMMARY OF BACKGROUND DATA: The advent of efficacious neoadjuvant treatment has led to renewed interest in PAR. Debate remains regarding the prognostic impact of the type of artery resected on short and long-term outcomes. METHODS: We retrospectively evaluated all consecutive PARs performed between September 1, 1991, and July 30, 2024. Multivariate logistic and Cox analyses were performed to identify prognostic factors for major morbidity and survival. RESULTS: A total of 278 patients consecutively underwent PAR during the study period. The type of artery resected included the hepatic arteries (HA) (n=74), superior mesenteric artery (SMA) (n=75), celiac trunk (CT) (n=117), and others (n=12). Simultaneously, venous resection was carried out on 247 patients (88.8%). Postoperative mortality and morbidity rates over 90 days stood at 5.39% and 47% respectively. From a multivariate regression analysis for severe morbidity, the following were identified as independent prognostic factors: need for more than six perioperative blood red units (HR: 2.24; CI 95%: 1.41-4.39; P=0.002), and POPF (HR: 3.64; CI 95%: 1.63-8.13; P=0.002). Median overall survival (OS) was 26 months from diagnosis and following surgery was 20 months (95% CI: 15.7-24.2 mo) with 1-, 3-, and 5-year survival rates of 69%, 28%, and 17% respectively. OS was similar among PAR: HA (18.8 mo, 17.8%), SMA (15.8 mo, 21.7%), CT (23.2 mo, 16%). Normal /normalized preoperative CA 19-9 (HR: 0.69; 95% CI: 0.48-0.98; P=0.04) and tumor size (T3, T4) (HR: 3.26; 95% CI: 1.72-6.16; P=0.008) were prognostic factors for OS. CONCLUSIONS: The type of arterial resection does not influence the prognosis for patients with pancreatic adenocarcinomas undergoing PAR. The biological and pathological response to preoperative treatment are better predictors of the prognosis after PAR for adenocarcinoma.