Vascular Reconstruction During Pancreatoduodenectomy for Ductal Adenocarcinoma of the Pancreas Improves Resectability but does not Achieve Cure

• Published in: World journal of surgery 2010-11, Vol.34 (11), p.2648-2661
• Main Authors: Ouaissi, Mehdi, Hubert, Catherine, Verhelst, Robert, Astarci, Parla, Sempoux, Christine, Jouret-Mourin, Anne, Loundou, Anderson, Gigot, Jean-François
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Arteries - surgery; Biological and medical sciences; Carcinoma, Pancreatic Ductal - surgery; Cardiac Surgery; Female; General aspects; General Surgery; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Pancreatic Cancer; Pancreatic Fistula; Pancreatic Neoplasms - surgery; Pancreatic Resection; Pancreaticoduodenectomy - methods; Retrospective Studies; Stomach, duodenum, intestine, rectum, anus; Superior Mesenteric Artery; Superior Mesenteric Vein; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thoracic Surgery; Vascular Surgery; Vascular Surgical Procedures; Veins - surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0699-6

Objective Combined vascular and pancreatic resection improves long-term survival of patients suffering from ductal adenocarcinoma of the pancreatic head. This study was designed to compare the results of surgical resection in patients with pancreatic cancer with or without vascular resection. Late 10-year disease-free survival was considered as an indicator of patients’ disease cure. Methods A total of 149 consecutive patients have undergone pancreatoduodenectomy without vascular resection (group 1: 82 patients), with isolated venous resection (group B: 67 patients), or with arterial and/or venous resection (group C: 8 patients). Results The duration of surgery and blood losses were significantly more important in groups B and C compared with group A; however, postoperative morbidity and mortality rates were similar. R1 resection was significantly more frequent in groups B (42%) and C (50%) compared with group A (13%; p  = 0.0002), but there were more advanced tumors in these groups, as demonstrated by a lower Karnowsky index, higher Ca 19-9 plasmatic level, greater tumor size, more advanced stage in the AJCC classification, and more tumor location in the uncinate process of the pancreas. Ten-year overall and disease-free survivals were significantly better in group A (19 and 20%) compared with group B (2.8 and 0%) and group C (0% and 0%). Multivariate analysis proved vascular resection and metastatic nodal status as being independent predictive factors of disease-free survival. Conclusions Vascular resection combined to pancreatoduodenectomy for pancreatic cancer increases local resectability without increasing mortality and morbidity rates but does not improve patients’ disease cure rate.