Article

Martin RC II, Scoggins CR, Egnatashvili V, et al. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes

Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.93). 03/2009; 144(2):154-9. DOI: 10.1001/archsurg.2008.547
Source: PubMed

ABSTRACT

Aggressive preoperative and intraoperative management may improve the resectability rates and outcomes for locally advanced pancreatic adenocarcinoma with venous involvement. The efficacy and use of venous resection and especially arterial resection in the management of pancreatic adenocarcinoma remain controversial.
Retrospective review of patients entered into prospective databases.
Two tertiary referral centers.
A retrospective review of 2 prospective databases of 593 consecutive pancreatic resections for pancreatic adenocarcinoma from January 1, 1999, through May 1, 2007.
Of the 593 patients, 36 (6.1%) underwent vascular resection at the time of pancreatectomy. Thirty-one of the 36 (88%) underwent venous resection alone; 3 (8%), combined arterial and venous resection; and 2 (6%), arterial resection (superior mesenteric artery resection) alone. Patients included 18 men and 18 women, with a median age of 62 (range, 42-82) years. The 90-day perioperative mortality and morbidity rates were 0% and 35%, respectively, compared with 2% and 39%, respectively, for the group undergoing nonvascular pancreatic resection (P = .34). Median survival was 18 (range, 8-42) months in the vascular resection group compared with 19 months in the nonvascular resection group. Multivariate analysis demonstrated node-positive disease, tumor location (other than head), and no adjuvant therapy as adverse prognostic variables.
In this combined experience, en bloc vascular resection consisting of venous resection alone, arterial resection alone, or combined vascular resection at the time of pancreatectomy for adenocarcinoma did not adversely affect postoperative mortality, morbidity, or overall survival. The need for vascular resection should not be a contraindication to surgical resection in the selected patient.

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    • "If the tumor and surrounding blood vessels (PV and SMV) were difficult to separate (e.g., because the tumor surrounded the blood vessels or because of inflammatory adhesion) during the surgery, vascular resection and reconstruction were performed to achieve complete removal of the tumor. To most surgeons, invasion of the artery is an absolute contraindication to surgical resection [12]–[13]. However, in our study, several such cases received PD with artery resection and reconstruction. "
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    ABSTRACT: The aim of this study was to present the therapeutic outcome of patients with locally advanced pancreatic cancer treated with pancreatoduodenectomy combined with vascular resection and reconstruction in addition to highlighting the mortality/morbidity and main prognostic factors associated with this treatment. We retrospectively analyzed the clinical and pathological data of a total of 566 pancreatic cancer patients who were treated with PD from five teaching hospitals during the period of December 2006-December 2011. This study included 119 (21.0%) patients treated with PD combined with vascular resection and reconstruction. We performed a detailed statistical analysis of various factors, including postoperative complications, operative mortality, survival rate, operative time, pathological type, and lymph node metastasis. The median survival time of the 119 cases that received PD combined with vascular resection was 13.3 months, and the 1-, 2-, and 3-year survival rates were 30.3%, 14.1%, and 8.1%, respectively. The postoperative complication incidence was 23.5%, and the mortality rate was 6.7%. For the combined vascular resection group, complications occurred in 28 cases (23.5%). For the group without vascular resection, complications occurred in 37 cases (8.2%). There was significant difference between the two groups (p = 0.001). The degree of tumor differentiation and the occurrence of complications after surgery were independent prognostic factors that determined the patients' long-term survival. Compared with PD without vascular resection, PD combined with vascular resection and reconstruction increased the incidence of postoperative complications. However, PD combined with vascular resection and reconstruction could achieve the complete removal of tumors without significantly increasing the mortality rate, and the median survival time was higher than that of patients who underwent palliative treatment. In addition, the two independent factors affecting the postoperative survival time were the degree of tumor differentiation and the presence or absence of postoperative complications.
    Full-text · Article · Aug 2013 · PLoS ONE
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    • "Depending on the length of tumor adherence, the portal and superior mesenteric vein can be reconstructed by a direct anastomosis or the interposition of a graft. Both procedures can be performed safely, which has been demonstrated in large series that showed surgical morbidity and mortality rates comparable to pancreatic head resections without vascular involvement [57-59]. In a systematic review published in 2006 [60], 52 manuscripts with more than 6300 patients were included in whom PDAC resection was performed. "
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    ABSTRACT: Pancreatic cancer is still associated with a poor prognosis and remains-as the fourth leading cause of cancer related mortality-a therapeutic challenge. Overall long-term survival is about 1-5%, and in only 10-20% of pancreatic cancer patients is potentially curative surgery possible, increasing five-year survival rates to approximately 20-25%. Pancreatic surgery is a technically challenging procedure and has significantly changed during the past decades with regard to technical aspects as well as perioperative care. Standardized resections can be carried out with low morbidity and mortality below 5% in high volume institutions. Furthermore, there is growing evidence that also more extended resections including multivisceral approaches, vessel reconstructions or surgery for tumor recurrence can be carried out safely with favorable outcomes. The impact of adjuvant treatment, especially chemotherapy, has increased dramatically within recent years, leading to significantly improved postoperative survival, making pancreatic cancer therapy an interdisciplinary approach to achieve best results.
    Full-text · Article · Dec 2011 · Cancers
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    ABSTRACT: Background: Pancreatic cancer is still associated with a poor prognosis and remains - as the fourth leading cause of cancer-related mortality - a therapeutic challenge. Overall long-term survival is about 1-5%, in only 10-20% of pancreatic cancer patients potentially curative surgery is possible, increasing 5-year survival rates to approximately 20-25%. Pancreatic surgery is a technically challenging procedure and has significantly changed during the past decades with regard to technical aspects as well as perioperative care. Methods: The current state of pancreatic cancer surgery is summarized with regard to standard indications and extended approaches. The available literature including randomized controlled trials and meta-analyses are included in this review article. Results: Standardized resections are well established and can be carried out with low morbidity and mortality below 5% in high-volume institutions. Furthermore, there is growing evidence that also more extended resections including multivisceral approaches, vessel reconstructions or surgery for tumor recurrence can be carried out safely with favorable outcome. In addition, the impact of adjuvant treatment, especially chemotherapy, has increased dramatically within recent years, leading to significantly improved survival in resected pancreatic cancer patients. Conclusions: Pancreatic resections are the basis of any curative approach in pancreatic cancer treatment and can be performed with low morbidity and mortality in high-volume institutions. Furthermore, pancreatic cancer needs to be in an interdisciplinary approach to achieve best results.
    No preview · Article · Dec 2009 · European Surgery
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